Basic Information
Provider Information
NPI: 1679797070
EntityType: 2
ReplacementNPI:  
OrganizationName: MAIMONIDES MEDICAL CENTER
LastName:  
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Credential:  
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Mailing Information
Address1: 123 SUTTER AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112124526
CountryCode: US
TelephoneNumber: 7189222075
FaxNumber:  
Practice Location
Address1: 4802 10TH AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112192916
CountryCode: US
TelephoneNumber: 7182836000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/13/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: WILLIAMS
AuthorizedOfficialFirstName: CAROLYN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PHSYICIAN ASSISTANT
AuthorizedOfficialTelephone: 7189222075
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: RPAC
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X0038601NYY HospitalsGeneral Acute Care Hospital 

No ID Information.


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