Provider Demographics
NPI:1205829611
Name:MARKEWICH, MAURICE ELISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:ELISH
Last Name:MARKEWICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:65 BACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3501
Mailing Address - Country:US
Mailing Address - Phone:914-769-7114
Mailing Address - Fax:212-420-2044
Practice Address - Street 1:301 E 21ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6543
Practice Address - Country:US
Practice Address - Phone:212-674-2979
Practice Address - Fax:212-420-2044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1091502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00193444Medicaid
0087207OtherGHI
0087207OtherGHI
C11401Medicare UPIN