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General NPI Number Information
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NPI Number | 1841952934
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Entity Type | Organization
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Legal Business Name | BMMG HEALTH COMPANY LLC
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 251 E OAKLAND AVE STE 1B
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2602
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Country | US
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Telephone | 631-228-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 251 E OAKLAND AVE STE 1B
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2602
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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 | MANAGER
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Name | BRIAN MCMAHON
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Credential |
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Telephone | 631-379-8218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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