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General NPI Number Information
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NPI Number | 1851588990
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Entity Type | Organization
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Legal Business Name | MILLBROOK MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 28 FRONT STREET
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City | MILLBROOK
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State | NY
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Zip | 12545
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Country | US
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Telephone | 845-677-8358
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Fax | 845-677-6205
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Provider Business Mailing Address
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Address Line | PO BOX 256
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City | MILLBROOK
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State | NY
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Zip | 12545-0256
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Country | US
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Telephone | 845-677-8358
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Fax | 845-677-6205
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Authorized Official
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Title or Position | MD
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Name | DR. MAHMOUD IBRAHIM HAMZA
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Credential |
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Telephone | 845-677-8358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 237858
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License Number State | NY
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