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General NPI Number Information
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NPI Number | 1659110484
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Entity Type | Organization
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Legal Business Name | MODERN MEDICAL NY PC
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 18555 COLLINS AVE APT 2905
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-2770
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Country | US
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Telephone | 786-546-5214
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Fax |
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Provider Business Mailing Address
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Address Line | 18555 COLLINS AVE APT 2905
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-2770
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. JASON BUCHWALD
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Credential | MD
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Telephone | 786-546-5214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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