Provider Demographics
NPI:1912954132
Name:OLGA M MAIMON MD PC
Entity Type:Organization
Organization Name:OLGA M MAIMON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-360-0117
Mailing Address - Street 1:3 HOSPITAL PLZ
Mailing Address - Street 2:STE 405
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3093
Mailing Address - Country:US
Mailing Address - Phone:732-360-0117
Mailing Address - Fax:732-360-0033
Practice Address - Street 1:758 ROUTE 18 STE 103A
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4923
Practice Address - Country:US
Practice Address - Phone:732-360-0117
Practice Address - Fax:732-360-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07825200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093022Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER