Healthcare Provider Details

I. General information

NPI: 1831282474
Provider Name (Legal Business Name): MARIA I BETANCOURT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MADISON AVE SUITE 800
NEW YORK NY
10016-4325
US

IV. Provider business mailing address

185 MADISON AVE SUITE 800
NEW YORK NY
10016-4325
US

V. Phone/Fax

Practice location:
  • Phone: 212-532-1111
  • Fax: 212-532-1185
Mailing address:
  • Phone: 212-532-1111
  • Fax: 212-532-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number182264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: