Provider Demographics
NPI:1417375312
Name:MAITRE, VENEL
Entity Type:Individual
Prefix:
First Name:VENEL
Middle Name:
Last Name:MAITRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6904
Mailing Address - Country:US
Mailing Address - Phone:631-254-6516
Mailing Address - Fax:631-254-6516
Practice Address - Street 1:54 DUKE ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729
Practice Address - Country:US
Practice Address - Phone:631-254-6516
Practice Address - Fax:631-254-6516
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649778-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse