Provider Demographics
NPI:1538506076
Name:COMMUNITY MEDICAL DISORDER P.C.
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL DISORDER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:MEADOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-218-6888
Mailing Address - Street 1:721 FLUSHING AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4419
Mailing Address - Country:US
Mailing Address - Phone:718-218-6888
Mailing Address - Fax:718-218-6855
Practice Address - Street 1:721 FLUSHING AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4419
Practice Address - Country:US
Practice Address - Phone:718-218-6888
Practice Address - Fax:718-218-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090294103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03345420Medicaid
NYA400067616OtherMEDICARE PTAN