Healthcare Provider Details

I. General information

NPI: 1114184017
Provider Name (Legal Business Name): MMC AT SARAH BURKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

100 CORPORATE DR CMO
YONKERS NY
10701-6807
US

V. Phone/Fax

Practice location:
  • Phone: 914-378-6163
  • Fax:
Mailing address:
  • Phone: 914-378-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G DOWLING
Title or Position: DIRECTOR PROVIDER INFORMATION
Credential:
Phone: 914-377-4668