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NPI Code Detail

MEDICARE: MMC AT JACKSON AVE FAMILY RESIDENCE

MEDICARE: MMC AT JACKSON AVE FAMILY RESIDENCE
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
1261QP2300XPrimary Care Clinic/Center7000006HNY

General Provider Information

NPI Number : 1326232091
Entity Type Code : Organization
Provider Name (Legal Business Name) : MMC AT JACKSON AVE FAMILY RESIDENCE
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 : 691 EAST 138TH STREET
Second Line : MMC AT JACKSON AVE FAMILY RESIDEN
City : BRONX
State : NY
Zip : 10454-3307
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 : 09/05/2007
Last Update Date : 09/05/2007

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Directions to “MMC AT JACKSON AVE FAMILY RESIDENCE ” Practice Location

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