MEDICARE: MAUREEN GAINE NP

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	363LF0000X	Family Nurse Practitioner	335023	NY

General Provider Information

NPI Number	:	1912233347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN GAINE NP

Provider Business Mailing Address
First Line	:	622 W. 168TH STREET
Second Line	:	PH 12
City	:	NEW YORK
State	:	NY
Zip	:	10032-0000
Country	:	US
Telephone Number	:	212-305-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W. 168TH STREET
Second Line	:	PH 12
City	:	NEW YORK
State	:	NY
Zip	:	10032-0000
Country	:	US
Telephone Number	:	212-305-7600
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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