1457521890 NPI number — DR. JESSIE KUMUDINIDEVI SAVERIMUTTU M.D.

Table of content: DR. JESSIE KUMUDINIDEVI SAVERIMUTTU M.D. (NPI 1457521890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457521890 NPI number — DR. JESSIE KUMUDINIDEVI SAVERIMUTTU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVERIMUTTU
Provider First Name:
JESSIE
Provider Middle Name:
KUMUDINIDEVI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457521890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
398 GOWER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10314-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-417-0747
Provider Business Mailing Address Fax Number:
718-865-5134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
398 GOWER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314-5333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-417-0747
Provider Business Practice Location Address Fax Number:
718-865-5134
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  246193 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9235428 . This is a "ADENA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P4206731 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3125050 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1750734 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060QH1 . This is a "BLUES CROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03179884 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: ID PH 43101 . This is a "ELDER PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000600057348 . This is a "HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5190872 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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