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DSH330194Q MAIMONIDES MEDICAL CENTER (Active)
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Main Details
Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
MAIMONIDES CARDIOLOGY OUTPATIENT CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330194Q
Medicare Provider Number
330194
Outpatient Facility Provider Number
330194
Additional Details
Current Program Status
Active
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Maimonides Medical Center
John Marshall, EVP MedAffair/Chair MedOfficer
(718) 283-8313
Primary Contact
Maimonides Medical Center
Yevgenia Bukher, Assistant Director, Pharmacy
(718) 283-7232
Addresses
Street Address
850 49TH ST
BROOKLYN, NY 11220-2429
Billing Address
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, NY 11219
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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