Healthcare Provider Details

I. General information

NPI: 1356426480
Provider Name (Legal Business Name): MARY ANN HAINES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WESTCHESTER AVE MMG - BRONX EAST
BRONX NY
10462-5072
US

IV. Provider business mailing address

2300 WESTCHESTER AVE MMG - BRONX EAST, URGENT CARE CENTER
BRONX NY
10462-5072
US

V. Phone/Fax

Practice location:
  • Phone: 718-829-1900
  • Fax: 718-409-8023
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number247184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: