Provider Demographics
NPI:1780956284
Name:MMC PEDIATRIC HOSPITAL MEDICINE FPP
Entity type:Organization
Organization Name:MMC PEDIATRIC HOSPITAL MEDICINE FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PEDIATRICS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-283-7500
Mailing Address - Street 1:977 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8159
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty