Healthcare Provider Details

I. General information

NPI: 1972642726
Provider Name (Legal Business Name): MARY NALBANDIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH STREET LUTHERAN MEDICAL CENTER
BROOKLYN NY
11220
US

IV. Provider business mailing address

113 EAST 64 ST
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7452
  • Fax: 718-630-6322
Mailing address:
  • Phone: 212-327-1686
  • Fax: 212-288-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number167455 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: