Provider Demographics
NPI:1710669015
Name:MAIDEN LANE MEDICAL, PLLC
Entity Type:Organization
Organization Name:MAIDEN LANE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-290-9560
Mailing Address - Street 1:90 MAIDEN LN RM 300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4725
Mailing Address - Country:US
Mailing Address - Phone:646-290-9560
Mailing Address - Fax:212-532-4362
Practice Address - Street 1:222 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4842
Practice Address - Country:US
Practice Address - Phone:646-290-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAIDEN LANE MEDICAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty