Provider Demographics
NPI:1275611527
Name:SAUL MASLAVI MD PC
Entity Type:Organization
Organization Name:SAUL MASLAVI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASLAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-717-0003
Mailing Address - Street 1:4232 FRANCIS LEWIS BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2561
Mailing Address - Country:US
Mailing Address - Phone:718-717-0003
Mailing Address - Fax:718-225-6936
Practice Address - Street 1:4232 FRANCIS LEWIS BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2561
Practice Address - Country:US
Practice Address - Phone:718-717-0003
Practice Address - Fax:718-225-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03226693Medicaid
NYWEN441Medicare PIN
H92485Medicare UPIN
NY03226693Medicaid