Provider Demographics
NPI:1194818419
Name:MORGAN, MAXINE PAMELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:PAMELA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:600 PORTION RD
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-1867
Practice Address - Country:US
Practice Address - Phone:631-471-5900
Practice Address - Fax:631-471-5901
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY186411207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330231Medicare ID - Type Unspecified
NY00246075Medicaid