NPIMap

Organization Active NPI

MMC at PS 105

  • Primary Care Clinic/Center
  • Bronx, NY
National Provider Identifier
1790979466
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
7000006H Issued in NY
Legal business name
MMC AT PS 105
Practice address
725 Brady Avenue
MMC at PS 105
Bronx, NY 10462-2701
Phone
(914) 377-4722
NPI assigned
Sep 5, 2007
Organization subpart
Yes
Parent organization
MONTEFIORE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

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

Authorized official

Name
Michael G Dowling
Title
Director
Phone
(914) 377-4668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 7000006H NY Primary

Addresses

Primary practice location

725 Brady Avenue
MMC at PS 105
Bronx, NY 10462-2701

Mailing address

100 Corporate Drive
Cmo
Yonkers, NY 10701
Phone (914) 377-4722

National Provider Directory

National Provider Directory
Tax ID family
MMC at Icahn House Family Shelter520 organizations share this tax ID, including this one
Part of
MMC at Icahn House Family Shelter

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

725 Brady Ave
#105
Bronx, NY 10462

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188950400000",
    "number": "1790979466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CORPORATE DRIVE",
            "address_2": "CMO",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "10701",
            "telephone_number": "914-377-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 BRADY AVENUE",
            "address_2": "MMC AT PS 105",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622701",
            "telephone_number": "914-377-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMC AT PS 105",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTEFIORE MEDICAL CENTER",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-09-05",
        "status": "A",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "7000006H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.