Basic Information
| Provider Information | |||||||||
| NPI: | 1013573799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAVI | ||||||||
| FirstName: | MAXINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 KINGS PL | ||||||||
| Address2: | |||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110241646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168491649 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | METROPOLITAN HOSPITAL DEPARTMENT OF DENTISTRY | ||||||||
| Address2: | 1901 1ST AVENUE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2019 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 061330 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.