Provider Demographics
NPI:1811940851
Name:MODERN MEDICAL PLLC
Entity type:Organization
Organization Name:MODERN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WERZBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-998-2222
Mailing Address - Street 1:2044 OCEAN AVE
Mailing Address - Street 2:SUITE A6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7328
Mailing Address - Country:US
Mailing Address - Phone:718-998-2222
Mailing Address - Fax:718-998-2693
Practice Address - Street 1:2044 OCEAN AVE
Practice Address - Street 2:SUITE A6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7328
Practice Address - Country:US
Practice Address - Phone:718-998-2222
Practice Address - Fax:718-998-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02769148Medicaid
NY02769148Medicaid