Provider Demographics
NPI:1669647004
Name:MMS MEDICAL
Entity Type:Organization
Organization Name:MMS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPP
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-934-9720
Mailing Address - Street 1:PO BOX 350583
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-0583
Mailing Address - Country:US
Mailing Address - Phone:718-934-9720
Mailing Address - Fax:
Practice Address - Street 1:3820 NOSTRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2000
Practice Address - Country:US
Practice Address - Phone:718-934-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01416779Medicaid