MMC SURGICAL CRITICAL CARE FACULTY PRACTICE PLAN (NPI# 1154481802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154481802 |
| Entity Type | Organization |
| Organization Name | MMC SURGICAL CRITICAL CARE FACULTY PRACTICE PLAN |
| Practice Address |
4802 10th Ave Brooklyn NY 11219-2916 |
| Mailing Address |
Gpo Box 27374 New York NY 10087-7374 |
| Practice Telephone | 7182838773 |
| Practice Fax Number | 7182838773 |
| Mailing Telephone | 7182838773 |
| Mailing Fax Number | 7182838773 |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2019-09-20 |
| Authorized Official Name | GAIL SIMHON (VP) |
| Authorized Official Telephone | 7182837285 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
Allopathic & Osteopathic Physicians |
| Street Address |
4802 10TH AVE |
| City | BROOKLYN |
| State | NY |
| Zip Code | 11219-2916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316943871 | Samantha Paige Jellinek | Pharmacist | 4802 10th Ave, Brooklyn, NY 11219-2844 | 2005-06-21 |
| 1730789959 | Arjun Basnet | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-10-27 |
| 1679171623 | Shehanaz Shajahan | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-10-13 |
| 1215534524 | Syed Mohammad Mazhar Uddin | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-10-08 |
| 1619581899 | Laurel Wright | Psychologist | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-09-03 |
| 1780296749 | Rabiah Ashraf | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-08-20 |
| 1275142820 | Jenna Danae Katherine Kroeker | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-07-29 |
| 1720696347 | Jay Donald Keith | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-07-20 |
| 1003424912 | Amit Dhaliwal | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-07-16 |
| 1912515826 | Supraja Achuthanandan | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2020-07-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073127163 | Chava Bokchin | Registered Nurse | 6200 15th Avenue, Brooklyn, NY 11219 | 2020-09-04 |
| 1164033643 | Debbie Evadne Evans-wright | Nurse Practitioner | 979 48th Street, Brooklyn, NY 11219 | 2020-08-10 |
| 1528614559 | Jonathan Benjamin Goldstein | Specialist | Yeled Vyalda 1312 38 Street, Brooklyn, NY 11219 | 2019-08-15 |
| 1235782301 | Vanessa Walton | Social Worker | 4012 New Utrecht Avenue, Apt 1, Brooklyn, NY 11219 | 2019-07-18 |
| 1083184618 | Sandra Murray | Licensed Practical Nurse | 6321 New Utrecht Avenue Second Floor, Brooklyn, NY 11219 | 2018-11-27 |
| 1023588746 | Wanipa Muwowo-nwade | Physician Assistant | 4802 10th Ave Rm 301, Brooklyn, NY 11219 | 2018-11-26 |
| 1366919896 | Evelin Ponce | Licensed Practical Nurse | 6321 New Utrecht Avenue, Second Floor, Brooklyn, NY 11219 | 2018-11-02 |
| 1083180301 | Yefim Simkhayev | Occupational Therapist | 1317 52nd St, Brooklyn, NY 11219 | 2018-10-15 |
| 1598240186 | F & D Pharmacy Inc | Pharmacy | 5504 -13 Ave, Brooklyn, NY 11219 | 2018-09-28 |
| 1245737469 | Yekaterina Joltikov | Student in an Organized Health Care Education/Training Program | Miamonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219 | 2018-04-13 |
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| Taxonomy Code | 2086S0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Critical Care |
| A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700991239 | Timothy S Hall | Surgery | 2601 Ocean Parkway, Coney Island Hospital, Brooklyn, NY 11235 | 2006-08-21 |
| 1407865702 | Qamar Amiruddin | Surgery | 1435 86th St., 2nd Floor, Brooklyn, NY 11228-3403 | 2006-08-05 |
| 1548788193 | Shannan Rae Winker | Surgery | 150 55th Street, Brooklyn, NY 11220 | 2017-09-05 |
| 1447511662 | Elizabeth Sim | Surgery | 450 Clarkson Ave, Box 1262, Brooklyn, NY 11203-2012 | 2012-06-05 |
| 1295093250 | Onaona Uanoe Gurney | Surgery | 450 Clarkson Ave, Box 1262, Brooklyn, NY 11203 | 2012-04-27 |
| 1902049471 | Maimonides Medical Center Acute Care Surgery Fpp | Surgery | 4802 10th Ave, Brooklyn, NY 11219-2916 | 2009-04-14 |
| 1649430067 | Tim Schwartz | Surgery | 451 Clarkson Ave, Brooklyn, NY 11203-2054 | 2008-06-10 |
| 1073771051 | Leon Dimitrios Boudourakis | Surgery | 451 Clarkson Ave, Box 22, Brooklyn, NY 11203-2054 | 2008-05-27 |
| 1881604197 | Manuel Lagmay | Surgery | 2601 Ocean Pkwy, Brooklyn, NY 11235-7745 | 2006-08-09 |
| 1417967746 | Muthukumar Muthusamy | Surgery | 2601 Ocean Pkwy, Brooklyn, NY 11235-7745 | 2006-08-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.