Provider Demographics
NPI:1881679736
Name:CHAIT, MAXWELL MANI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:MANI
Last Name:CHAIT
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 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-9817
Mailing Address - Fax:914-593-7881
Practice Address - Street 1:180 E HARTSDALE AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3544
Practice Address - Country:US
Practice Address - Phone:914-725-2010
Practice Address - Fax:914-593-7881
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116549207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00951931OtherRAILROAD MEDICARE PTAN
NY00599624Medicaid
NYA100000178OtherPTAN
NYA400027730OtherMEDICARE PTAN
NYA400027730OtherMEDICARE PTAN
NYD34147Medicare UPIN
NY664291Medicare ID - Type Unspecified