Provider Demographics
NPI:1346062643
Name:JM MEDICAL PRACTICE PC
Entity type:Organization
Organization Name:JM MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-338-0567
Mailing Address - Street 1:169 MADISON AVE STE 11579
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5101
Mailing Address - Country:US
Mailing Address - Phone:908-312-3755
Mailing Address - Fax:
Practice Address - Street 1:153 W 27TH ST STE 702
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6255
Practice Address - Country:US
Practice Address - Phone:908-312-3755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMER HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty