Provider Demographics
NPI:1851450696
Name:MAYREIS, MAXINE (DC)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:
Last Name:MAYREIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MAXINE
Other - Middle Name:CAPPEL
Other - Last Name:MAYREIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:480 FOREST AVE REAR
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2151
Mailing Address - Country:US
Mailing Address - Phone:516-759-7702
Mailing Address - Fax:516-674-0572
Practice Address - Street 1:480 FOREST AVE REAR
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2151
Practice Address - Country:US
Practice Address - Phone:516-759-7702
Practice Address - Fax:516-674-0572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU33856Medicare UPIN
NYX47011Medicare ID - Type Unspecified