Provider Demographics
NPI:1790436426
Name:MMD COMMUNITY CARE
Entity Type:Organization
Organization Name:MMD COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OSAYAMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-808-9515
Mailing Address - Street 1:155 MAIN ST UNIT 500
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-8018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 4TH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2315
Practice Address - Country:US
Practice Address - Phone:908-808-9515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health