Provider Demographics
NPI:1760533277
Name:OSTEOPATHIC MANIPULATIVE MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:OSTEOPATHIC MANIPULATIVE MEDICINE ASSOCIATES
Other - Org Name:OMM ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-364-7565
Mailing Address - Street 1:575 UNDERHILL BLVD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3426
Mailing Address - Country:US
Mailing Address - Phone:516-364-7565
Mailing Address - Fax:
Practice Address - Street 1:575 UNDERHILL BLVD
Practice Address - Street 2:SUITE 126
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3426
Practice Address - Country:US
Practice Address - Phone:516-364-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184291183544204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWER251Medicare PIN