Provider Demographics
NPI:1831282474
Name:BETANCOURT, MARIA I (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MADISON AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4325
Mailing Address - Country:US
Mailing Address - Phone:212-532-1111
Mailing Address - Fax:212-532-1185
Practice Address - Street 1:185 MADISON AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4325
Practice Address - Country:US
Practice Address - Phone:212-532-1111
Practice Address - Fax:212-532-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1074357OtherAETNA HMO
NY133652484OtherTAX ID
NY80N41OtherEMPIRE BC/BS
NY4295360OtherAETNA PPO
NYNP751OtherOXFORD
NYOMO783OtherPHCS
NY182264OtherHIP
NY448588OtherCIGNA
NYE62807Medicare UPIN
NY133652484OtherTAX ID