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Organization
MK HEALTHCARE MEDICAL PC
Active
Organization
MK HEALTHCARE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL AMBAR (CREDENTIALING MANAGER)
(917) 748-1913
Entity
Organization
Contact information
Practice address
5629 METROPOLITAN AVE, RIDGEWOOD, NY 11385
(718) 418-0300
(718) 418-0301
Mailing address
5629 METROPOLITAN AVE, RIDGEWOOD, NY 11385-1975
(718) 418-0300
(718) 418-0301
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
149503
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00825003
—
NY
01
—
149503
LICENSE
NY
Enumeration date
08/10/2018
Last updated
09/16/2022
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