Provider Demographics
NPI:1679465025
Name:MM NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:MM NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAKROUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASHREKY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:347-278-3824
Mailing Address - Street 1:7726 62ND ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6810
Mailing Address - Country:US
Mailing Address - Phone:347-278-3824
Mailing Address - Fax:
Practice Address - Street 1:7726 62ND ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6810
Practice Address - Country:US
Practice Address - Phone:347-278-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty