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General NPI Number Information
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NPI Number | 1932394020
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Entity Type | Organization
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Legal Business Name | MAYRA S MAHADIN M D P C
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 3757 91ST ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7901
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Country | US
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Telephone | 718-651-6500
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Fax | 718-651-0634
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Provider Business Mailing Address
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Address Line | 3757 91ST ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7901
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Country | US
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Telephone | 718-651-6500
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Fax | 718-651-0634
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAYRA S MAHADIN
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Credential | M.D.
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Telephone | 718-651-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 155360
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License Number State | NY
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