Provider Demographics
NPI:1417200247
Name:MAIMONIDES INTERNAL MEDICINE FPP
Entity Type:Organization
Organization Name:MAIMONIDES INTERNAL MEDICINE FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-283-8773
Mailing Address - Street 1:GPO BOX 27633
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7633
Mailing Address - Country:US
Mailing Address - Phone:718-283-8773
Mailing Address - Fax:
Practice Address - Street 1:9101 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6368
Practice Address - Country:US
Practice Address - Phone:718-283-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty