Provider Demographics
NPI:1508191024
Name:MAIMONIDES MEDICAL CENTER
Entity Type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:XIAO
Authorized Official - Middle Name:QING
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-283-5900
Mailing Address - Street 1:4721 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2927
Mailing Address - Country:US
Mailing Address - Phone:718-283-5900
Mailing Address - Fax:718-635-7630
Practice Address - Street 1:4721 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2927
Practice Address - Country:US
Practice Address - Phone:718-283-5900
Practice Address - Fax:718-635-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038221282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital