Individual
JEFFRY MUTUC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
645 10TH AVE, NEW YORK, NY 10036-2904
(212) 265-4500
Mailing address
645 10TH AVE, NEW YORK, NY 10036-2904
(212) 265-4500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
300176
NY
Other
Enumeration date
03/22/2017
Last updated
08/18/2020
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