Provider Demographics
NPI:1184609802
Name:MILLENNIUM MEDICAL SERVICES, PC
Entity type:Organization
Organization Name:MILLENNIUM MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:VENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-236-9446
Mailing Address - Street 1:7400 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5612
Mailing Address - Country:US
Mailing Address - Phone:718-236-9446
Mailing Address - Fax:718-236-3854
Practice Address - Street 1:7400 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5612
Practice Address - Country:US
Practice Address - Phone:718-236-9446
Practice Address - Fax:718-236-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCF8730OtherRAILROAD MEDICARE
NYW32381Medicare ID - Type UnspecifiedGROUP NUMBER