Healthcare Provider Details

I. General information

NPI: 1104827773
Provider Name (Legal Business Name): KAREN A MAYBANK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WILSON AVE
BROOKLYN NY
11207-2175
US

IV. Provider business mailing address

620 WILSON AVE
BROOKLYN NY
11207-2175
US

V. Phone/Fax

Practice location:
  • Phone: 917-279-2480
  • Fax:
Mailing address:
  • Phone: 917-279-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228477
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number228477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: