Provider Demographics
NPI:1114371986
Name:MAXIMILIAN MEDICAL, LLC
Entity Type:Organization
Organization Name:MAXIMILIAN MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-880-7802
Mailing Address - Street 1:21 SHAFER PL
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6622
Mailing Address - Country:US
Mailing Address - Phone:201-880-7802
Mailing Address - Fax:201-880-7804
Practice Address - Street 1:21 SHAFER PL
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6622
Practice Address - Country:US
Practice Address - Phone:201-880-7802
Practice Address - Fax:201-880-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies