Healthcare Provider Details

I. General information

NPI: 1881889160
Provider Name (Legal Business Name): MMC AT STREETWORKS OUTREACH PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC AT STREETWORKS OUTREACH PROJECT 545 EIGHTH AVENUE
NEW YORK NY
10018-4307
US

IV. Provider business mailing address

CMO 100 CORPORATE DRIVE
YONKERS NY
10701
US

V. Phone/Fax

Practice location:
  • Phone: 914-377-4722
  • Fax:
Mailing address:
  • Phone: 914-377-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number7000006H
License Number StateNY

VIII. Authorized Official

Name: MICHAEL G DOWLING
Title or Position: DIRECTOR
Credential:
Phone: 914-377-4668