Healthcare Provider Details

I. General information

NPI: 1265547178
Provider Name (Legal Business Name): MAIMONIDES MEDICAL CENTER - MAIMO CRITICARE FPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 49TH ST SUITE 511
BROOKLYN NY
11219-2923
US

IV. Provider business mailing address

953 49TH ST SUITE 511
BROOKLYN NY
11219-2923
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8380
  • Fax: 718-283-7884
Mailing address:
  • Phone: 718-283-8380
  • Fax: 718-283-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: SIDNEY TESSLER
Title or Position: DIRECTOR, DIV. OF PULM/CRIT CARE
Credential: MD
Phone: 718-283-8380