Healthcare Provider Details

I. General information

NPI: 1326045477
Provider Name (Legal Business Name): MMC OB GYN PERINATAL DIAGNOSTIC ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 FORT HAMILTON PARKWAY
BROOKLYN NY
11234
US

IV. Provider business mailing address

5014 FORT HAMILTON PARKWAY
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8941
  • Fax: 718-635-8977
Mailing address:
  • Phone: 718-283-8941
  • Fax: 718-635-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHOSHANA HABERMAN
Title or Position: DIRECTOR
Credential: MD
Phone: 718-283-8943