Provider Demographics
NPI:1376198838
Name:MAISEL LOTAN, ADI MAISEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ADI
Middle Name:MAISEL
Last Name:MAISEL LOTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7928
Mailing Address - Country:US
Mailing Address - Phone:917-747-3389
Mailing Address - Fax:
Practice Address - Street 1:450 E 63RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7928
Practice Address - Country:US
Practice Address - Phone:917-747-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100366-012086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery