Basic Information
| Provider Information | |||||||||
| NPI: | 1801809041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAIMONIDESMEDICALCENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 1OTH AVENUE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182836000 | ||||||||
| FaxNumber: | 7182838498 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801- 10TH AVENUE | ||||||||
| Address2: | DEPARTMENT OF MEDICINE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182836000 | ||||||||
| FaxNumber: | 7182838498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NARRO | ||||||||
| AuthorizedOfficialFirstName: | VERONICA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | WOUND CONSULTANT | ||||||||
| AuthorizedOfficialTelephone: | 7182836000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRACTITIONER | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | F300541 | NY | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 02196514 | 05 | NY | MEDICAID |