MEDICARE: MUMTAZ JAHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	216654	NY

General Provider Information

NPI Number	:	1952358079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUMTAZ JAHAN MD

Provider Business Mailing Address
First Line	:	121 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5425
Country	:	US
Telephone Number	:	718-250-8000
Fax Number	:	718-250-6609

Provider Business Practice Location Address
First Line	:	2748 BUTLER ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11369-1928
Country	:	US
Telephone Number	:	718-576-6667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/06/2015

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