Provider Demographics
NPI:1902330509
Name:MUNIVAR, AZIM MOMIN (MD)
Entity type:Individual
Prefix:MR
First Name:AZIM
Middle Name:MOMIN
Last Name:MUNIVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 GEORGE ST SUITE 901
Mailing Address - Street 2:YALE UNIVERSITY DEPARTMENT OF PSYCHIATRY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:210-785-2095
Mailing Address - Fax:
Practice Address - Street 1:300 GEORGE ST SUITE 901
Practice Address - Street 2:YALE UNIVERSITY DEPARTMENT OF PSYCHIATRY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:210-785-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT638202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program