1487843413 NPI number — MMC CHILD ADVOCACY CENTER AT 3380

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487843413 NPI number — MMC CHILD ADVOCACY CENTER AT 3380

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMC CHILD ADVOCACY CENTER AT 3380
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487843413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMO
Provider Second Line Business Mailing Address:
100 CORPORATE DRIVE
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-377-4722
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MMC CHILD ADVOCACY CENTER AT 3380
Provider Second Line Business Practice Location Address:
3380 RESERVOIR OVAL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-377-4722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOWLING
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
914-377-4668

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  7000006H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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