Healthcare Provider Details

I. General information

NPI: 1417988106
Provider Name (Legal Business Name): MARIA BOUZOUKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVE @ 16TH STREET
NEW YORK NY
10003
US

IV. Provider business mailing address

1780 BROADWAY 1100
BROOKLYN NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8880
  • Fax: 212-844-6807
Mailing address:
  • Phone: 212-590-2930
  • Fax: 212-590-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number133267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: