Provider Demographics
NPI:1780910976
Name:MMC NUTRITION CENTER FPP
Entity type:Organization
Organization Name:MMC NUTRITION CENTER FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-283-8773
Mailing Address - Street 1:GPO BOX 27369
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7369
Mailing Address - Country:US
Mailing Address - Phone:718-283-8777
Mailing Address - Fax:718-283-8796
Practice Address - Street 1:4702 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2926
Practice Address - Country:US
Practice Address - Phone:718-283-8777
Practice Address - Fax:718-283-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty