Provider Demographics
NPI:1851327654
Name:MAISEL, LOUIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:M
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-0547
Mailing Address - Country:US
Mailing Address - Phone:845-708-0900
Mailing Address - Fax:845-708-0931
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5200
Practice Address - Country:US
Practice Address - Phone:845-708-0900
Practice Address - Fax:845-708-0931
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01474262Medicaid
NY01474262Medicaid
NY382B7ANL41Medicare PIN