Provider Demographics
NPI:1205216322
Name:MAXWELL 21 MEDICAL, PC
Entity Type:Organization
Organization Name:MAXWELL 21 MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:THANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUISOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-952-9355
Mailing Address - Street 1:111 BROADWAY RM 503
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1981
Mailing Address - Country:US
Mailing Address - Phone:212-952-9355
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY RM 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1981
Practice Address - Country:US
Practice Address - Phone:212-952-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty