Healthcare Provider Details

I. General information

NPI: 1326109570
Provider Name (Legal Business Name): MMC SURGICAL ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

GPO BOX 27399
NEW YORK NY
10087-7399
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 Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

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