Basic Information
| Provider Information | |||||||||
| NPI: | 1205221199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINSON | ||||||||
| FirstName: | MAURICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4615 47TH AVE | ||||||||
| Address2: | |||||||||
| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113776116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127469663 | ||||||||
| FaxNumber: | 2127463609 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 JFK PKWY FL 1 | ||||||||
| Address2: | |||||||||
| City: | SHORT HILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070782713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127469663 | ||||||||
| FaxNumber: | 2127463609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 286739 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.