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NPI Code Detail

MEDICARE: DR. MARY H USUBIAGA MD

MEDICARE: DR. MARY H USUBIAGA MD
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
12084P0804XChild & Adolescent Psychiatry PhysicianP64275NY

General Provider Information

NPI Number : 1740443415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY H USUBIAGA MD
Provider Business Mailing Address
First Line : 1819 BERGEN ST RM 220
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-4513
Country : US
Telephone Number : 718-613-3112
Fax Number :
Provider Business Practice Location Address
First Line : 1819 BERGEN ST RM 220
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-4513
Country : US
Telephone Number : 718-613-3112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2008
Last Update Date : 12/20/2022

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