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General NPI Number Information
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NPI Number | 1407107774
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Entity Type | Individual
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Provider Name | MAGDALINE MAVROMATIS
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Gender | Female
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 806 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10065-7316
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Country | US
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Telephone | 212-838-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 207-12 27TH AVENUE
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City | BAYSIDE
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State | NY
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Zip | 11360
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Country | US
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Telephone | 718-279-1165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 039709
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License Number State | NY
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