Healthcare Provider Details

I. General information

NPI: 1225462617
Provider Name (Legal Business Name): MODERN MEDICAL CARE OF NY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 56TH ST
BROOKLYN NY
11220-3503
US

IV. Provider business mailing address

8766 23RD AVE
BROOKLYN NY
11214-5202
US

V. Phone/Fax

Practice location:
  • Phone: 718-435-3890
  • Fax: 718-435-3489
Mailing address:
  • Phone: 917-767-2918
  • Fax: 718-435-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number219028-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number219028-1
License Number StateNY

VIII. Authorized Official

Name: MR. DEYE WEI
Title or Position: ANESTHESIOLOGIST/OWNER
Credential: M.D.
Phone: 917-767-2918