Provider Demographics
NPI:1801809041
Name:MAIMONIDESMEDICALCENTER
Entity type:Organization
Organization Name:MAIMONIDESMEDICALCENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOUND CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NARRO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:718-283-6000
Mailing Address - Street 1:4801 1OTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2801
Mailing Address - Country:US
Mailing Address - Phone:718-283-6000
Mailing Address - Fax:718-283-8498
Practice Address - Street 1:4801- 10TH AVENUE
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2801
Practice Address - Country:US
Practice Address - Phone:718-283-6000
Practice Address - Fax:718-283-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300541282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02196514Medicaid
NYS54540Medicare UPIN
95V452Medicare ID - Type Unspecified