NPI Record of MMC MEDICAL PARK AT 1635 POPLAR NPI 1003000779

Clinic/Center (Primary Care) in Bronx, NY

Complete NPI Record

Field Name Value Definition
NPI1003000779The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameMMC MEDICAL PARK AT 1635 POPLARThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing AddressCMOThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address100 CORPORATE DRIVEThe second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameYONKERSThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameNYThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code10701The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number9143774722The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location AddressMMC MEDICAL PARK AT 1635 POPLARThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address1635 POPLAR STREETThe second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBRONXThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNYThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code104612659The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number9143774722The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date9/5/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date9/5/2007The date that a record was last updated or changed.
Authorized Official Last NameDOWLINGThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameMICHAELThe first name of the authorized official.
Authorized Official Middle NameGThe middle name of the authorized official.
Authorized Official Title or PositionDIRECTORThe title or position of the authorized official.
Authorized Official Telephone Number9143774668The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QP2300XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 17000006HThe license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1NYThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartY
Parent Organization LBNMONTEFIORE MEDICAL CENTER
Parent Organization TINUNAVAIL