Basic Information
| Provider Information | |||||||||
| NPI: | 1780910976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MMC NUTRITION CENTER FPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | GPO BOX 27369 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838777 | ||||||||
| FaxNumber: | 7182838796 | ||||||||
| Practice Location | |||||||||
| Address1: | 4702 FORT HAMILTON PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838777 | ||||||||
| FaxNumber: | 7182838796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2009 | ||||||||
| LastUpdateDate: | 10/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | CAMMER | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7182838773 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.