Provider Demographics
NPI:1265254098
Name:MAVEN CLINIC ADMINISTRATORS INC.
Entity type:Organization
Organization Name:MAVEN CLINIC ADMINISTRATORS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ARWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-345-3676
Mailing Address - Street 1:160 VARICK ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1272
Mailing Address - Country:US
Mailing Address - Phone:212-868-6655
Mailing Address - Fax:
Practice Address - Street 1:160 VARICK ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1272
Practice Address - Country:US
Practice Address - Phone:212-868-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAVEN CLINIC CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical