Provider Demographics
NPI:1205279031
Name:MOMENTUM MEDICAL SERVICES, PC.
Entity type:Organization
Organization Name:MOMENTUM MEDICAL SERVICES, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-801-6375
Mailing Address - Street 1:9323 SHORE ROAD
Mailing Address - Street 2:SUITE # 4L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6640
Mailing Address - Country:US
Mailing Address - Phone:718-801-6375
Mailing Address - Fax:516-629-2458
Practice Address - Street 1:9323 SHORE ROAD
Practice Address - Street 2:SUITE # 4L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6640
Practice Address - Country:US
Practice Address - Phone:718-801-6375
Practice Address - Fax:516-629-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184477208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY184477OtherNYS LICENSE