Provider Demographics
NPI:1235390790
Name:MMC WOMENS SERVICES,FPP
Entity Type:Organization
Organization Name:MMC WOMENS SERVICES,FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCENTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-748-6632
Mailing Address - Street 1:9201 4TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7006
Mailing Address - Country:US
Mailing Address - Phone:718-748-1234
Mailing Address - Fax:718-748-0353
Practice Address - Street 1:9201 4TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7006
Practice Address - Country:US
Practice Address - Phone:718-748-1234
Practice Address - Fax:718-748-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW2U821Medicare PIN