Healthcare Provider Details

I. General information

NPI: 1780956284
Provider Name (Legal Business Name): MMC PEDIATRIC HOSPITAL MEDICINE FPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

977 48TH ST
BROOKLYN NY
11219-2919
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7500
  • Fax:
Mailing address:
  • Phone: 718-283-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE FOLTIN
Title or Position: DIRECTOR, PEDIATRICS
Credential: MD
Phone: 718-283-7500