Healthcare Provider Details

I. General information

NPI: 1760521959
Provider Name (Legal Business Name): MODERN MEDICAL PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN ST FL 1
HASTINGS ON HUDSON NY
10706-1602
US

IV. Provider business mailing address

PO BOX 110
HASTINGS ON HUDSON NY
10706-0110
US

V. Phone/Fax

Practice location:
  • Phone: 914-478-5121
  • Fax: 866-862-1608
Mailing address:
  • Phone: 914-478-5121
  • Fax: 866-862-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number238747 1
License Number StateNY

VIII. Authorized Official

Name: DR. OXANA POPESCU
Title or Position: OFFICER
Credential: MD
Phone: 917-627-7591