Provider Demographics
NPI:1801927850
Name:MAXWELL MEDICAL IMAGING, PC
Entity type:Organization
Organization Name:MAXWELL MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-693-1555
Mailing Address - Street 1:75 PARK PL
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2146
Mailing Address - Country:US
Mailing Address - Phone:212-693-1555
Mailing Address - Fax:
Practice Address - Street 1:75 PARK PL
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2146
Practice Address - Country:US
Practice Address - Phone:212-693-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085B0100X, 2085N0700X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEMPLOYER ID NUMBER
NYWT7461Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER