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General NPI Number Information
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NPI Number | 1679465025
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Entity Type | Organization
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Legal Business Name | MM NURSE PRACTITIONER IN FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 7726 62ND ST
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City | GLENDALE
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State | NY
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Zip | 11385-6810
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Country | US
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Telephone | 347-278-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 7726 62ND ST
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City | GLENDALE
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State | NY
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Zip | 11385-6810
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Country | US
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Telephone | 347-278-3824
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. MAKROUS M MASHREKY
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Credential | FNP
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Telephone | 347-278-3824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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