MEDICARE: MMC AT PROSPECT INTERFAITH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	7000006H	NY

General Provider Information

NPI Number	:	1073708319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMC AT PROSPECT INTERFAITH CENTER

Provider Business Mailing Address
First Line	:	100 CORPORATE DRIVE
Second Line	:	CMO
City	:	YONKERS
State	:	NY
Zip	:	10701
Country	:	US
Telephone Number	:	914-377-4722
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 KELLY STREET
Second Line	:	MMC AT PROSPECT INTERFAITH CENTER
City	:	BRONX
State	:	NY
Zip	:	10455-1911
Country	:	US
Telephone Number	:	914-377-4722
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL G DOWLING
Credential	:
Telephone Number	:	914-377-4668

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

Similar Medicare Providers

1255525929 — MMC AT PROSPECT INTERFAITH CENTER
Practice Location Address:

730 KELLY STREET , MMC AT PROSPECT INTERFAITH CENTER
BRONX, NY
10455-1911

Practice Phone: 914-377-4722
Practice Fax:

1518332378 — JEROME DUPONT
Practice Location Address:

730 KELLY ST
BRONX, NY
10455-1911

Practice Phone: 718-542-4127
Practice Fax:

1437734142 — SUZETTE PATRICIA LANCASTER MSW, CASAC-T
Practice Location Address:

730 KELLY ST
BRONX, NY
10455-1911

Practice Phone: 718-542-4127
Practice Fax:

1003556432 — ISAAC BOWEN
Practice Location Address:

730 KELLY ST
BRONX, NY
10455-1911

Practice Phone: 718-542-4127
Practice Fax:

1154031219 — RACHEL S ELLERSON LMSW
Practice Location Address:

730 KELLY ST
BRONX, NY
10455-1911

Practice Phone: 718-542-4127
Practice Fax:

1649157215 — MS. NIASIA C NORMAN I
Practice Location Address:

730 KELLY ST APT E2
BRONX, NY
10455-1911

Practice Phone: 347-366-4141
Practice Fax:

Directions to “MMC AT PROSPECT INTERFAITH CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.