1841383569 NPI number — DR. MARY JANE MAXWELL PH.D.

Table of content: DR. MARY JANE MAXWELL PH.D. (NPI 1841383569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841383569 NPI number — DR. MARY JANE MAXWELL PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXWELL
Provider First Name:
MARY
Provider Middle Name:
JANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841383569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 E 75TH ST
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-2639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-517-7342
Provider Business Mailing Address Fax Number:
718-423-3223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 E 75TH ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-517-7342
Provider Business Practice Location Address Fax Number:
718-423-3223
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  008011-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02033190 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0067723 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 64986 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DR9064 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: V50610 . This is a "EMPIRE BCBS PROVIDER NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 437643 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 147145 . This is a "VALUE OPTIONS PROVIDER NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6180606 . This is a "UNITED HEALTHCARE PROV NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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