Basic Information
Provider Information
NPI: 1306184916
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FALAMAKI
FirstName: MARYAMNAZ
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19134 MISSION MANOR LN
Address2:  
City: RICHMOND
State: TX
PostalCode: 774073639
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 234 E 149TH ST
Address2:  
City: BRONX
State: NY
PostalCode: 104515504
CountryCode: US
TelephoneNumber: 7185796476
FaxNumber: 7185795246
Other Information
ProviderEnumerationDate: 01/17/2013
LastUpdateDate: 01/17/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  Y HospitalsGeneral Acute Care Hospital 

No ID Information.


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