Healthcare Provider Details

I. General information

NPI: 1487614202
Provider Name (Legal Business Name): MARIA I JAIME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 FULTON ST
BROOKLYN NY
11216-2505
US

IV. Provider business mailing address

1456 FULTON ST
BROOKLYN NY
11216-2505
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-4500
  • Fax: 347-296-8310
Mailing address:
  • Phone: 718-636-4500
  • Fax: 347-296-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: