Provider Demographics
NPI:1114920451
Name:MAIDA, EMANUEL MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:MARTIN
Last Name:MAIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S LIVINGSTON AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4042
Mailing Address - Country:US
Mailing Address - Phone:973-535-6266
Mailing Address - Fax:973-535-2810
Practice Address - Street 1:209 S LIVINGSTON AVE
Practice Address - Street 2:STE 7
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4042
Practice Address - Country:US
Practice Address - Phone:973-535-6266
Practice Address - Fax:973-535-2810
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04942800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00294733OtherRAILROAD MEDICARE
E94376Medicare UPIN
NJP00294733OtherRAILROAD MEDICARE