Organization
AYSAR BENYAMEN FATHALAH-MAMMO,PHYSICIAN,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AYSAR B FATHALLAH-MAMMO MD (PRESIDENT)
(516) 801-0662
Entity
Organization
Contact information
Practice address
8000 4TH AVE, BROOKLYN, NY 11209-3959
(718) 748-2818
(718) 833-1016
Mailing address
372 ELM DR, ROSLYN, NY 11576-3013
(516) 801-0662
(718) 833-1016
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
212576
NY
Other
Enumeration date
03/31/2011
Last updated
03/31/2011
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