Provider Demographics
NPI:1598027435
Name:MAXWELL BOEV MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MAXWELL BOEV MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-267-7510
Mailing Address - Street 1:90 OFFICE PKWY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1749
Mailing Address - Country:US
Mailing Address - Phone:585-267-7510
Mailing Address - Fax:585-267-7511
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-342-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
137227207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03436082Medicaid
NYB75305Medicare UPIN
NY6710610001Medicare NSC