Provider Demographics
NPI:1750827762
Name:MAVENCARE (NY) INC.
Entity Type:Organization
Organization Name:MAVENCARE (NY) INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, US OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MBA
Authorized Official - Phone:646-853-1126
Mailing Address - Street 1:79 MADISON AVE # 438
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7802
Mailing Address - Country:US
Mailing Address - Phone:646-887-2333
Mailing Address - Fax:
Practice Address - Street 1:79 MADISON AVE # 438
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7802
Practice Address - Country:US
Practice Address - Phone:646-887-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04488515Medicaid