Basic Information
| Provider Information | |||||||||
| NPI: | 1972681484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MEDICAL & DENTAL CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONSEY FAMILY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 ROBERT PITT DRIVE | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453526800 | ||||||||
| FaxNumber: | 8453527293 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 ROBERT PITT DRIVE | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453526800 | ||||||||
| FaxNumber: | 8453527293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOFFMAN | ||||||||
| AuthorizedOfficialFirstName: | MENDEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 8453526800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 01432975 | 05 | NY | MEDICAID |