Provider Demographics
NPI:1124593082
Name:MOUNTVIEW MEDICAL PC
Entity Type:Organization
Organization Name:MOUNTVIEW MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-964-3930
Mailing Address - Street 1:829 57TH ST # 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3677
Mailing Address - Country:US
Mailing Address - Phone:718-964-3930
Mailing Address - Fax:
Practice Address - Street 1:829 57TH ST # 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3677
Practice Address - Country:US
Practice Address - Phone:718-964-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty