Provider Demographics
NPI:1578572137
Name:MAXIM MOBILITY LLC
Entity Type:Organization
Organization Name:MAXIM MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAZZOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-772-2445
Mailing Address - Street 1:90 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-772-2445
Mailing Address - Fax:203-772-0855
Practice Address - Street 1:90 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-772-2445
Practice Address - Fax:203-772-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0621CT01OtherANTHEM BCBS
A600202OtherOXFORD
A600202OtherOXFORD