Provider Demographics
NPI:1417911686
Name:MAESAKA, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:MAESAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-663-2169
Mailing Address - Fax:516-663-2179
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-663-2169
Practice Address - Fax:516-663-2179
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY100559207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10491029OtherCAQH
NY00928978Medicaid
NYAM1553456OtherDEA
NY513071Medicare ID - Type Unspecified
NYAM1553456OtherDEA