Provider Demographics
NPI:1104281286
Name:MM MEDICAL SERVICE PC
Entity type:Organization
Organization Name:MM MEDICAL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-897-2228
Mailing Address - Street 1:PO BOX 230406
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-0406
Mailing Address - Country:US
Mailing Address - Phone:718-897-2228
Mailing Address - Fax:718-897-2251
Practice Address - Street 1:76-55 AUSTIN STREET
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6948
Practice Address - Country:US
Practice Address - Phone:718-897-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty