Basic Information
| Provider Information | |||||||||
| NPI: | 1932374568 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAIMONIDES MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 CRYSTAL CT | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109252857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455951061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4802 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182836000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | GALE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6463024309 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 012500 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.