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General NPI Number Information
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NPI Number | 1043405228
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Entity Type | Organization
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Legal Business Name | MMC CHAM
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | MMC CHAM 3415 BAINBRIDGE AVENUE
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City | BRONX
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State | NY
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Zip | 10467-2403
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Country | US
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Telephone | 914-377-4722
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Fax |
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Provider Business Mailing Address
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Address Line | CMO 102 CORPORATE DRIVE
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City | YONKERS
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State | NY
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Zip | 10701
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Country | US
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Telephone | 914-377-4724
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHAEL G DOWLING
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Credential |
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Telephone | 914-377-4668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 7000006H
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License Number State | NY
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