Basic Information
| Provider Information | |||||||||
| NPI: | 1265461917 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAXIM MANAGEMENT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3085 HARLEM RD | ||||||||
| Address2: | STE 350 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Practice Location | |||||||||
| Address1: | 3085 HARLEM RD | ||||||||
| Address2: | STE 350 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 06/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | TERHAAR | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7166088700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.