Provider Demographics
NPI:1386410587
Name:JOSE M MARIA FAMILY HEALTH NURSE PRACTITIONER PC
Entity type:Organization
Organization Name:JOSE M MARIA FAMILY HEALTH NURSE PRACTITIONER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-518-6593
Mailing Address - Street 1:3184 GRAND CONCOURSE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1031
Mailing Address - Country:US
Mailing Address - Phone:917-518-6593
Mailing Address - Fax:
Practice Address - Street 1:3184 GRAND CONCOURSE APT 2D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1031
Practice Address - Country:US
Practice Address - Phone:917-518-6593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06342974Medicaid