Provider Demographics
NPI:1386034023
Name:MAYNARD ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:MAYNARD ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-259-0436
Mailing Address - Street 1:520 E 72ND ST
Mailing Address - Street 2:STE LCD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4849
Mailing Address - Country:US
Mailing Address - Phone:212-259-0436
Mailing Address - Fax:
Practice Address - Street 1:520 E 72ND ST
Practice Address - Street 2:STE LCD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4849
Practice Address - Country:US
Practice Address - Phone:212-259-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty