Provider Demographics
NPI:1164608501
Name:MAIMONIDES MEDICAL CENTER DIVISION OF OTOLARYNGOLOGY FPP
Entity Type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER DIVISION OF OTOLARYNGOLOGY FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-283-8326
Mailing Address - Street 1:919 49TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2923
Mailing Address - Country:US
Mailing Address - Phone:718-283-8326
Mailing Address - Fax:718-283-8261
Practice Address - Street 1:919 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2923
Practice Address - Country:US
Practice Address - Phone:718-283-8326
Practice Address - Fax:718-283-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152258207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty