Provider Demographics
NPI:1366526667
Name:MARIADASON, JAMES GAETAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GAETAN
Last Name:MARIADASON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:401 E 86TH ST
Mailing Address - Street 2:APT 5J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6403
Mailing Address - Country:US
Mailing Address - Phone:212-600-0455
Mailing Address - Fax:212-600-4035
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY,METROPOLITAN HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6614
Practice Address - Fax:212-423-7913
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY150217208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037443Medicaid
NY01037443Medicaid
NYE17721Medicare UPIN