Provider Demographics
NPI:1215648779
Name:MMM HEALTH SERVICES, INC
Entity type:Organization
Organization Name:MMM HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-2905
Mailing Address - Street 1:596 ANDERSON AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:596 ANDERSON AVE STE 305
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1888
Practice Address - Country:US
Practice Address - Phone:201-945-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMM HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071796Medicaid