MEDICARE: MAGDALINE MAVROMATIS

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	183500000X	Pharmacist	039709	NY

General Provider Information

NPI Number	:	1407107774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDALINE MAVROMATIS

Provider Business Mailing Address
First Line	:	207-12 27TH AVENUE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360
Country	:	US
Telephone Number	:	718-279-1165
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7316
Country	:	US
Telephone Number	:	212-838-2500
Fax Number	:

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

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	09/27/2012

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Directions to “ MAGDALINE MAVROMATIS ” Practice Location

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