Provider Demographics
NPI:1750672838
Name:PHILLIPS, MAUREEN (RPA-C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5 E 98TH ST # 1188
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-1924
Mailing Address - Fax:212-241-9710
Practice Address - Street 1:5 E 98TH ST # 1188
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-1924
Practice Address - Fax:212-241-9710
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013443363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical