Provider Demographics
NPI:1720009525
Name:MAISEL, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MAISEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SO OYSTER BAY RD
Mailing Address - Street 2:STE 305
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801
Mailing Address - Country:US
Mailing Address - Phone:516-939-6100
Mailing Address - Fax:516-939-2510
Practice Address - Street 1:400 SO OYSTER BAY RD
Practice Address - Street 2:STE 305
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801
Practice Address - Country:US
Practice Address - Phone:516-939-6100
Practice Address - Fax:516-939-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138708207W00000X
FLME0058247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00783188310003Medicaid
00D161OtherBCBS
58809POtherHIP
41409OtherUS HEALTH
41409OtherAETNA
3598OtherVYTRA PPO
AS1211OtherOXFORD
NY00783188310003Medicaid
A96048Medicare UPIN