Provider Demographics
NPI:1811901630
Name:MAPLE MEDICAL, LLP
Entity type:Organization
Organization Name:MAPLE MEDICAL, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LABORATORY
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DOMINICK
Authorized Official - Last Name:VIZIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-328-0932
Mailing Address - Street 1:170 MAPLE AVE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4710
Mailing Address - Country:US
Mailing Address - Phone:914-328-0932
Mailing Address - Fax:914-328-9851
Practice Address - Street 1:170 MAPLE AVE
Practice Address - Street 2:SUITE G1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4710
Practice Address - Country:US
Practice Address - Phone:914-328-0932
Practice Address - Fax:914-328-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0726624291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory