Provider Demographics
NPI:1073598850
Name:MAIMON, OLGA M (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:M
Last Name:MAIMON
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 1:758 ROUTE 18 STE 103A
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4923
Mailing Address - Country:US
Mailing Address - Phone:732-360-0117
Mailing Address - Fax:732-360-1141
Practice Address - Street 1:758 ROUTE 18 STE 103A
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4923
Practice Address - Country:US
Practice Address - Phone:732-360-0117
Practice Address - Fax:732-360-1141
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA078252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0071595Medicaid
NJI22363Medicare UPIN
NJ0071595Medicaid