Provider Demographics
NPI:1972556603
Name:MAYA'S MEDICAL P.C.
Entity Type:Organization
Organization Name:MAYA'S MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-730-0953
Mailing Address - Street 1:62 98 SAUNDERS ST.
Mailing Address - Street 2:#5L
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-743-7090
Mailing Address - Fax:
Practice Address - Street 1:9811 QUEENS BLVD
Practice Address - Street 2:LL3
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3323
Practice Address - Country:US
Practice Address - Phone:718-743-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231069207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231069Medicaid
NY231069Medicaid
NYI23844Medicare UPIN