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General NPI Number Information
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NPI Number | 1285648154
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Entity Type | Organization
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Legal Business Name | MMC PEDIATRICS FACULTY PRACTICE
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 948 48TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11219
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Country | US
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Telephone | 718-283-8260
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Fax | 718-283-6147
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Provider Business Mailing Address
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Address Line | 977 48TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-2919
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Country | US
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Telephone | 718-283-8015
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Fax | 718-635-7235
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Authorized Official
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Title or Position | CHAIRMAN, DEPARTMENT OF PEDIATRICS
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Name | STEVEN SHELOV
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Credential | MD
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Telephone | 718-283-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology 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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #11
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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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