Provider Demographics
NPI:1497291074
Name:MAIDEN LANE MEDICAL, PLLC
Entity Type:Organization
Organization Name:MAIDEN LANE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-290-9560
Mailing Address - Street 1:90 MAIDEN LN
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4831
Mailing Address - Country:US
Mailing Address - Phone:646-290-9560
Mailing Address - Fax:212-532-4362
Practice Address - Street 1:90 MAIDEN LN
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4831
Practice Address - Country:US
Practice Address - Phone:646-290-9560
Practice Address - Fax:212-532-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220289207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty