Provider Demographics
NPI:1740204114
Name:MMC PEDIATRIC CRITICAL CARE FPP
Entity Type:Organization
Organization Name:MMC PEDIATRIC CRITICAL CARE FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, DEPARTMENT OF PEDIATRICS
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-283-7500
Mailing Address - Street 1:977 48TH STREET
Mailing Address - Street 2:ATTENTION: KATHLYN ORLANDO
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:4802 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-283-8854
Practice Address - Fax:718-635-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty