Provider Demographics
NPI:1922422922
Name:QUALITY OF LIFE MEDICAL MANANGEMENT INC
Entity Type:Organization
Organization Name:QUALITY OF LIFE MEDICAL MANANGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMCHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-336-8000
Mailing Address - Street 1:2917 AVENUE K
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4053
Mailing Address - Country:US
Mailing Address - Phone:718-938-7369
Mailing Address - Fax:
Practice Address - Street 1:2917 AVENUE K
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4053
Practice Address - Country:US
Practice Address - Phone:718-938-7369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300103879Medicaid