MEDICARE: MGM MEDICAL SERVICES LLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1619634284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MGM MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	59 GLENORCHY PL
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-3512
Country	:	US
Telephone Number	:	646-345-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 KINDERKAMACK RD STE 103
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	201-267-4785
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. CHERYL MALINA
Credential	:	MD
Telephone Number	:	646-345-1998

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/18/2021

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