Provider Demographics
NPI:1225462617
Name:MODERN MEDICAL CARE OF NY PLLC
Entity Type:Organization
Organization Name:MODERN MEDICAL CARE OF NY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEYE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-767-2918
Mailing Address - Street 1:8766 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5202
Mailing Address - Country:US
Mailing Address - Phone:917-767-2918
Mailing Address - Fax:718-435-3489
Practice Address - Street 1:717 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3503
Practice Address - Country:US
Practice Address - Phone:718-435-3890
Practice Address - Fax:718-435-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219028-1207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02359460Medicaid
NY8L5191Medicare UPIN
NYH81247Medicare UPIN