Provider Demographics
NPI:1043399454
Name:MOOMJY, MAUREEN O'BRIEN (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:O'BRIEN
Last Name:MOOMJY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 60TH ST RM 1901
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1791
Mailing Address - Country:US
Mailing Address - Phone:212-230-1055
Mailing Address - Fax:877-832-3365
Practice Address - Street 1:30 E 60TH ST RM 1901
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1791
Practice Address - Country:US
Practice Address - Phone:212-230-1055
Practice Address - Fax:877-832-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189878207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
38G37OtherBLUE CROSS BLUE SHIELD
F77351Medicare UPIN