Healthcare Provider Details

I. General information

NPI: 1932590601
Provider Name (Legal Business Name): MODERN PHYSICIAN SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 GRAHAM AVE
BROOKLYN NY
11206-4017
US

IV. Provider business mailing address

85 BROAD ST FL 18
NEW YORK NY
10004-2783
US

V. Phone/Fax

Practice location:
  • Phone: 644-593-8773
  • Fax: 417-429-2893
Mailing address:
  • Phone: 646-604-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW SHULMAN
Title or Position: CEO
Credential:
Phone: 646-741-1511