Provider Demographics
NPI:1811689771
Name:BMJC MEDICAL
Entity type:Organization
Organization Name:BMJC MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNACCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:516-457-0783
Mailing Address - Street 1:2 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2625
Mailing Address - Country:US
Mailing Address - Phone:516-457-0783
Mailing Address - Fax:
Practice Address - Street 1:2 LOCUST LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2625
Practice Address - Country:US
Practice Address - Phone:516-457-0783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty