Healthcare Provider Details

I. General information

NPI: 1285720276
Provider Name (Legal Business Name): MMC REPRODUCTIVE ENDOCRINOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 84TH ST
BROOKLYN NY
11228-3030
US

IV. Provider business mailing address

1355 84TH ST
BROOKLYN NY
11228-3030
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8600
  • Fax: 718-283-6580
Mailing address:
  • Phone: 718-283-8600
  • Fax: 718-283-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number151465
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD V GRAZI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-283-8600