MEDICARE: MAIMONIDES MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	0038221	NY

General Provider Information

NPI Number	:	1508191024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIMONIDES MEDICAL CENTER

Provider Business Mailing Address
First Line	:	4721 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2927
Country	:	US
Telephone Number	:	718-283-5900
Fax Number	:	718-635-7630

Provider Business Practice Location Address
First Line	:	4721 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2927
Country	:	US
Telephone Number	:	718-283-5900
Fax Number	:	718-635-7630

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MS. XIAO QING MA
Credential	:
Telephone Number	:	718-283-5900

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	10/16/2009

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