MEDICARE: MAPLE OB/GYN, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	165139	NY

General Provider Information

NPI Number	:	1336241140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE OB/GYN, PC

Provider Business Mailing Address
First Line	:	136-25 MAPLE AVENUE
Second Line	:	SUITE 207
City	:	FLUSHING
State	:	NY
Zip	:	11355-0000
Country	:	US
Telephone Number	:	718-321-8500
Fax Number	:	718-460-4105

Provider Business Practice Location Address
First Line	:	136-25 MAPLE AVENUE
Second Line	:	SUITE 207
City	:	FLUSHING
State	:	NY
Zip	:	11355-0000
Country	:	US
Telephone Number	:	718-321-8500
Fax Number	:	718-460-4105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL CHI-CHOW KUO
Credential	:	M.D.
Telephone Number	:	718-321-8500

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	04/08/2010

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