Provider Demographics
NPI:1477514651
Name:MAIMONIDES MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SARENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-637-6654
Mailing Address - Street 1:1295 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2732
Mailing Address - Country:US
Mailing Address - Phone:321-637-6654
Mailing Address - Fax:321-433-1119
Practice Address - Street 1:1295 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2732
Practice Address - Country:US
Practice Address - Phone:321-637-6654
Practice Address - Fax:321-433-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379714700Medicaid