Provider Demographics
NPI:1811060833
Name:JULIAN, MAXIMO B (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:MAXIMO
Middle Name:B
Last Name:JULIAN
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Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:255 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1229
Mailing Address - Country:US
Mailing Address - Phone:212-568-1000
Mailing Address - Fax:212-740-1438
Practice Address - Street 1:255 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1229
Practice Address - Country:US
Practice Address - Phone:212-568-1000
Practice Address - Fax:212-740-1438
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY133408207Q00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00275296Medicaid
NY00275296Medicaid
NY332751Medicare ID - Type Unspecified