Provider Demographics
NPI:1932394020
Name:MAYRA S MAHADIN M D P C
Entity Type:Organization
Organization Name:MAYRA S MAHADIN M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-651-6500
Mailing Address - Street 1:3757 91ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7901
Mailing Address - Country:US
Mailing Address - Phone:718-651-6500
Mailing Address - Fax:718-651-0634
Practice Address - Street 1:3757 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7901
Practice Address - Country:US
Practice Address - Phone:718-651-6500
Practice Address - Fax:718-651-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155360207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty