Provider Demographics
NPI:1710219845
Name:KURTZ, MAYA (RPH)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HIGHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5747
Mailing Address - Country:US
Mailing Address - Phone:631-271-4979
Mailing Address - Fax:
Practice Address - Street 1:53 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2901
Practice Address - Country:US
Practice Address - Phone:516-931-1099
Practice Address - Fax:516-931-4932
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036927-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist