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MUDASSIR MUMTAZ MD
NPI 1639755218
Student in an Organized Health Care Education/Training Program in Port Jefferson, NY

Active since March 23, 2021
75 N COUNTRY RD, PORT JEFFERSON, NY 11777(631) 686-2549 Get Directions Write a Review

NPPES record last updated: March 23, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mudassir Mumtaz Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MUDASSIR MUMTAZ MD (NPI 1639755218) is an individual student in an organized health care education/training program in Port Jefferson, New York and active in the NPI registry since March 2021.

NPPES Registry Identity

NPI1639755218
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMUDASSIR MUMTAZCredential: MD
Location Address75 N COUNTRY RDPort Jefferson, NY 11777-2190
Mailing Address75 N Country RdPort Jefferson, NY 11777-2190 · (631) 686-2549
Phone(631) 686-2549
Sole ProprietorNo
Enumeration DateMarch 23, 2021
NPPES CertifiedMarch 23, 2021
✔ NPI 1639755218 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
75 N COUNTRY RD, Port Jefferson, NY 11777
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTINA CATHERINE MELLONE DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
AAKAASH VARMA MD
Dermatology
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
KRISELA VOJNIKU MD
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
LORETTA DIDWELL
Physician Assistant
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
RAYMOND WONG
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-7654
KATLYN ANN CONVILLE ANTHONY NP
Nurse Practitioner (Family)
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2565
SHEHNAZ WASIM MD
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-1443
JULIA KOROBENKO DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mudassir Mumtaz's NPI number?

The NPI number for Mudassir Mumtaz is 1639755218. It was assigned to this individual provider in the NPPES registry on March 23, 2021.

Where is Mudassir Mumtaz located?

Mudassir Mumtaz practices at 75 N Country Rd, Port Jefferson, NY 11777. The listed phone number is (631) 686-2549.

What is Mudassir Mumtaz's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Mudassir Mumtaz was last updated on March 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.