Provider Demographics
NPI:1669660759
Name:MAIMONIDES MEDICAL CENTER - INTERVENTIONAL NEURO ASSOCIATES FPP
Entity Type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER - INTERVENTIONAL NEURO ASSOCIATES FPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-283-8773
Mailing Address - Street 1:PO BOX 27613
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7613
Mailing Address - Country:US
Mailing Address - Phone:718-283-8773
Mailing Address - Fax:718-283-8796
Practice Address - Street 1:948 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2918
Practice Address - Country:US
Practice Address - Phone:718-283-8773
Practice Address - Fax:718-283-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1922302085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty