Healthcare Provider Details

I. General information

NPI: 1992996334
Provider Name (Legal Business Name): MAIMONIDES MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 STERLING PL APT 3B
BROOKLYN NY
11233-4520
US

IV. Provider business mailing address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

V. Phone/Fax

Practice location:
  • Phone: 718-774-5704
  • Fax:
Mailing address:
  • Phone: 718-283-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number004992
License Number StateNY

VIII. Authorized Official

Name: MS. JACQUELINE FAULK
Title or Position: CERTIFIED OCCUPATIONAL THERAPY ASSI
Credential: COTA
Phone: 718-283-6418