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General NPI Number Information
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NPI Number | 1629529508
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Entity Type | Organization
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Legal Business Name | MAIMONIDES MEDICAL CENTER
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 4802 TENTH AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11219
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Country | US
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Telephone | 718-283-8471
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Fax |
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Provider Business Mailing Address
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Address Line | 4802 10TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-2916
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Country | US
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Telephone | 718-283-8471
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE COORDINATOR, MU
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Name | MISS SUSAN MALIS
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Credential |
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Telephone | 718-283-5694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 175663
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License Number State | NY
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