Provider Demographics
NPI:1760567309
Name:HOMER, MARIA
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:HOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WHITSON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6852
Mailing Address - Country:US
Mailing Address - Phone:718-263-5364
Mailing Address - Fax:
Practice Address - Street 1:9429 59TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5150
Practice Address - Country:US
Practice Address - Phone:718-271-7400
Practice Address - Fax:718-271-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1358402080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1C4455OtherHEALTHNET PROV ID
NY00315586Medicaid
NYP434947OtherOXFORD HEALTH PLAN PROVID
NY31036732OtherLABCORP PROV ID
NY04894OtherQUEST LABS PROV ID
NY135840A17OtherHF 1199 HOME CARE PROV ID
NY1831X01OtherNYC DEPT OF HEALTH ID
NY0085974OtherGHI PROVIDER ID
NY16A361OtherEMPIRE BC&BS PROV ID
NY135840N01OtherHIP PROVIDER ID
54460NOtherCIGNA PROV ID
NY1073280001 &12-01215OtherUNITED HEALTHCARE PROV ID
NY135840OtherMEDICAL LICENSE
NY135840OtherMEDICAL LICENSE
NYBO7822Medicare UPIN