Provider Demographics
NPI:1659788321
Name:ALBANESE, MAX
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:
Last Name:ALBANESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 125TH ST 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2957
Mailing Address - Country:US
Mailing Address - Phone:888-973-7848
Mailing Address - Fax:
Practice Address - Street 1:105 ORANGE ST
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2957
Practice Address - Country:US
Practice Address - Phone:321-591-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI31092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist