| Organization Name: | MMC MEDICAL PARK AT 1635 POPLAR |
| NPI Number: | 1003000779 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL G DOWLING (DIRECTOR) |
| Mailing Address: | Mmc Medical Park At 1635 Poplar 1635 Poplar Street Bronx |
| State: | NY US |
| Postal Code: | 104612659 |
| Phone Number: | 9143774722 |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2007 |
| NPI Last Update Date: | 09/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 7000006H |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |