Provider Demographics
NPI:1851588990
Name:MILLBROOK MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:MILLBROOK MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:HAMZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-677-8358
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-0256
Mailing Address - Country:US
Mailing Address - Phone:845-677-8358
Mailing Address - Fax:845-677-6205
Practice Address - Street 1:28 FRONT STREET
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545
Practice Address - Country:US
Practice Address - Phone:845-677-8358
Practice Address - Fax:845-677-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY336ANIOtherMEDICARE