Provider Demographics
NPI:1508596222
Name:MAXICARE HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:MAXICARE HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWATOSIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLUNUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-409-1406
Mailing Address - Street 1:112 LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2036
Mailing Address - Country:US
Mailing Address - Phone:073-409-1406
Mailing Address - Fax:
Practice Address - Street 1:112 LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2036
Practice Address - Country:US
Practice Address - Phone:073-409-1406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty