Provider Demographics
NPI:1780867366
Name:THOMAS M. MAURI, MD, PC
Entity type:Organization
Organization Name:THOMAS M. MAURI, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-918-6300
Mailing Address - Street 1:865 NORTHERN BLVD
Mailing Address - Street 2:203
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5310
Mailing Address - Country:US
Mailing Address - Phone:516-918-6300
Mailing Address - Fax:516-918-6363
Practice Address - Street 1:865 NORTHERN BLVD
Practice Address - Street 2:203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5310
Practice Address - Country:US
Practice Address - Phone:516-918-6300
Practice Address - Fax:516-918-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148905 3261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598739989OtherPROVIDER NPI
NYB19175Medicare UPIN