Provider Demographics
NPI:1912192212
Name:MMC AT AMERICAN RED CROSS FAMILY SHELTER ICAHN EAST
Entity Type:Organization
Organization Name:MMC AT AMERICAN RED CROSS FAMILY SHELTER ICAHN EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-377-4668
Mailing Address - Street 1:CMO
Mailing Address - Street 2:100 CORPORATE DRIVE
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-377-4722
Mailing Address - Fax:
Practice Address - Street 1:MMC AT AMERICAN RED CROSS FAMILY SHELTER ICAHN EAST
Practice Address - Street 2:4 EAST 28TH STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7402
Practice Address - Country:US
Practice Address - Phone:914-377-4722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTEFIORE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000006H261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty