Provider Demographics
NPI:1558426080
Name:MAISEL & OSBORNE MD PLLC
Entity Type:Organization
Organization Name:MAISEL & OSBORNE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-708-0900
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-0520
Mailing Address - Country:US
Mailing Address - Phone:845-708-0900
Mailing Address - Fax:
Practice Address - Street 1:2426 EASTCHESTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5916
Practice Address - Country:US
Practice Address - Phone:718-708-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF26412Medicare UPIN