Basic Information
| Provider Information | |||||||||
| NPI: | 1336316116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAIMONIDES MEDICAL CENTER - BROOKLYN BREAST PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27400 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838773 | ||||||||
| FaxNumber: | 7182838796 | ||||||||
| Practice Location | |||||||||
| Address1: | 6300 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112204718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838773 | ||||||||
| FaxNumber: | 7182838796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | CAMMER | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 7182838773 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.