MEDICARE: DR. MAMTA M. MAMIK M.D.

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	4301085885	MI
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	267923	NY
3	207V00000X	Obstetrics & Gynecology Physician	MD2009-0223	NM

General Provider Information

NPI Number	:	1356531883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAMTA M. MAMIK M.D.

Provider Business Mailing Address
First Line	:	1400 PELHAM PKWY S
Second Line	:	BLDG 1, ROOM BS27
City	:	BRONX
State	:	NY
Zip	:	10461-1119
Country	:	US
Telephone Number	:	914-721-3359
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S
Second Line	:	BLDG 1, ROOM BS27
City	:	BRONX
State	:	NY
Zip	:	10461-1119
Country	:	US
Telephone Number	:	914-721-3359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	11/07/2019

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