NPIMap

Organization Active NPI

MMC Division of Breast Surgery

  • Surgery Physician
  • Brooklyn, NY
National Provider Identifier
1609980846
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MMC DIVISION OF BREAST SURGERY
Practice address
745 64TH St Ste 1
Brooklyn, NY 11220-4753
Phone
(718) 765-2570
Fax
(718) 765-2569
NPI assigned
Aug 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charusheela Andaz, MDNPI 1437163235
Title
Department Head
Phone
(718) 283-8773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

745 64TH St Ste 1
Brooklyn, NY 11220-4753

Mailing address

6300 8TH Ave
Brooklyn, NY 11220-4718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041210000805 NY Part B Supplier - Clinic/Group Practice 0244297240 Receives reassigned benefits from 11 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

6300 8th Ave
Fl 2
Brooklyn, NY 11220
Phone (718) 765-2550

Gpo 27400
New York, NY 10087

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1609980846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 8TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 64TH ST STE 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204753",
            "telephone_number": "718-765-2570",
            "fax_number": "718-765-2569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMC DIVISION OF BREAST SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "ANDAZ",
        "authorized_official_first_name": "CHARUSHEELA",
        "authorized_official_title_or_position": "DEPARTMENT HEAD",
        "authorized_official_telephone_number": "718-283-8773",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.