Healthcare Provider Details

I. General information

NPI: 1326620048
Provider Name (Legal Business Name): CHARLES CONWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIMONIDES MEDICAL CENTER 4802 10TH AVENUE
BROOKLYN NY
11219
US

IV. Provider business mailing address

MAIMONIDES MEDICAL CENTER 4802 10TH AVENUE
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-6000
  • Fax:
Mailing address:
  • Phone: 718-283-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2025054240
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: