Healthcare Provider Details

I. General information

NPI: 1942510920
Provider Name (Legal Business Name): MMC GYNECOLOGY ONCOLOGY FPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 49TH ST
BROOKLYN NY
11219-2923
US

IV. Provider business mailing address

GPO BOX 27630
NEW YORK NY
10087-7630
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8773
  • Fax: 718-283-8796
Mailing address:
  • Phone: 718-283-8773
  • Fax: 718-283-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MARTIN CAMMER
Title or Position: DIRECTOR
Credential:
Phone: 718-283-8773