Basic Information
| Provider Information | |||||||||
| NPI: | 1598878217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MMC HEMATOLOGY ONCOLOGY FPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | GPO BOX 27638 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877638 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6300 8TH AVE | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112204718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838773 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BATTAGLIA | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7182838773 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.