Provider Demographics
NPI:1346791845
Name:MAIMONIDES MEDICAL CENTER
Entity Type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHYSICIAN ASSISTANT, DOM
Authorized Official - Prefix:
Authorized Official - First Name:IGNAZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:718-283-8137
Mailing Address - Street 1:4802 10TH AVE
Mailing Address - Street 2:DEPARTMENT OF MEDICINE ADMINISTRATION BUILDING 301
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-283-8137
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:DEPARTMENT OF MEDICINE ADMINISTRATION BUILDING 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-283-8137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020010-1282N00000X, 282NC0060X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty