Basic Information
| Provider Information | |||||||||
| NPI: | 1184042574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXIM OF NEW YORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7227 LEE DEFOREST DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210463236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109101500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 224 HARRISON ST | ||||||||
| Address2: | SUITE 680 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132023056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154760600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2014 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | SIPES | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4109101500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1121L002 | NY | Y | Agencies | Home Health |
No ID Information.