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General NPI Number Information
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NPI Number | 1114320397
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Entity Type | Organization
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Legal Business Name | M2 MEDICAL COMMUNITY PRACTICE, P.C.
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 4802 10TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-2916
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Country | US
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Telephone | 718-283-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4802 10TH AVE EXECUTIVE OFFICE
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City | BROOKLYN
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State | NY
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Zip | 11219-2916
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Country | US
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Telephone | 718-283-6392
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VP
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Name | DAVID COHEN
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Credential | M.D.
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Telephone | 718-283-6392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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