Provider Demographics
NPI:1881720985
Name:M.M.J.J. INC.
Entity type:Organization
Organization Name:M.M.J.J. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-277-9515
Mailing Address - Street 1:64 CARLETON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1500
Mailing Address - Country:US
Mailing Address - Phone:631-277-9515
Mailing Address - Fax:631-277-7844
Practice Address - Street 1:64 CARLETON AVE STE B
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1500
Practice Address - Country:US
Practice Address - Phone:631-277-9515
Practice Address - Fax:631-277-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0177073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00759866Medicaid
NY3376034OtherNCPDP