Basic Information
| Provider Information | |||||||||
| NPI: | 1124149018 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROOKLYN WOMEN'S HEALTHCARE MDS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 78TH ST SUITE A | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182381276 | ||||||||
| FaxNumber: | 7189213448 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 78TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182381276 | ||||||||
| FaxNumber: | 7189213448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 04/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAHER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | OBSTETRICIAN AND GYNECOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7182381276 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.