MEDICARE: BMMG HEALTH COMPANY 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	261QR0800X	Recovery Care Clinic/Center

General Provider Information

NPI Number	:	1841952934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BMMG HEALTH COMPANY LLC

Provider Business Mailing Address
First Line	:	251 E OAKLAND AVE STE 1B
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 E OAKLAND AVE STE 1B
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2602
Country	:	US
Telephone Number	:	631-228-8700
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRIAN MCMAHON
Credential	:
Telephone Number	:	631-379-8218

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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Directions to “BMMG HEALTH COMPANY LLC ” Practice Location

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