Healthcare Provider Details

I. General information

NPI: 1003972944
Provider Name (Legal Business Name): MARGUERITE M MAYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - FAMILY CARE CENTER 3444 KOSSUTH AVENUE, 2ND FL.
BRONX NY
10467
US

IV. Provider business mailing address

3444 KOSSUTH AVE MMC
BRONX NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-5271
  • Fax: 718-652-5707
Mailing address:
  • Phone: 718-920-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number114891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: