Healthcare Provider Details

I. General information

NPI: 1912048331
Provider Name (Legal Business Name): MARIA I. BETANCOURT MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 MADISON AVE SUITE 200
NEW YORK NY
10016-6700
US

IV. Provider business mailing address

148 MADISON AVE SUITE 200
NEW YORK NY
10016-6700
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 Code302F00000X
TaxonomyExclusive Provider Organization
License Number182264
License Number StateNY

VIII. Authorized Official

Name: DR. MARIA I BETANCOURT
Title or Position: OWNER
Credential: MD
Phone: 212-532-1111