Provider Demographics
NPI:1093777492
Name:MAIMONIDES MEDICAL CENTER
Entity Type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT,PROFESSIONAL AFFAIRS
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBUS
Authorized Official - Suffix:
Authorized Official - Credentials:MJ, MPA, MSW
Authorized Official - Phone:718-283-8958
Mailing Address - Street 1:4802 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2844
Mailing Address - Country:US
Mailing Address - Phone:718-283-8958
Mailing Address - Fax:718-635-7105
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2844
Practice Address - Country:US
Practice Address - Phone:718-283-8958
Practice Address - Fax:718-635-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001020H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
71002OtherELDERPLAN
0007008OtherAETNAUSHEALTHCARE
NY02998736Medicaid
HO4400OtherOXFORD
NY000057OtherBLUE CROSS
IC0023OtherPHYSICIANS HEALTH
000502001OtherAMERICHOICE
NY02998736Medicaid