Provider Demographics
NPI:1356597256
Name:MAIMONIDES MEDICAL CENTER
Entity type:Organization
Organization Name:MAIMONIDES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:8/2008
Authorized Official - Phone:718-720-7498
Mailing Address - Street 1:555 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1532
Mailing Address - Country:US
Mailing Address - Phone:771-872-0749
Mailing Address - Fax:
Practice Address - Street 1:555 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1532
Practice Address - Country:US
Practice Address - Phone:771-872-0749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY455721-1282N00000X
NYF334700-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital