Provider Demographics
NPI:1316194020
Name:THYNE, MAUREEN (PA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:THYNE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E. 70TH ST
Mailing Address - Street 2:STARR 341
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9800
Mailing Address - Country:US
Mailing Address - Phone:646-962-2700
Mailing Address - Fax:212-746-8107
Practice Address - Street 1:520 E. 70TH ST.
Practice Address - Street 2:STARR 341
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:646-962-2700
Practice Address - Fax:212-746-8107
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00205700363A00000X
NY015144-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1849302OtherDEA