Healthcare Provider Details

I. General information

NPI: 1184326621
Provider Name (Legal Business Name): MAXIM BRAIN AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 RIDGEDALE AVE STE 225
CEDAR KNOLLS NJ
07927-2111
US

IV. Provider business mailing address

197 RIDGEDALE AVE STE 225
CEDAR KNOLLS NJ
07927-2111
US

V. Phone/Fax

Practice location:
  • Phone: 973-206-1477
  • Fax: 973-695-1645
Mailing address:
  • Phone: 973-206-1477
  • Fax: 973-695-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT ANDREW MEYER
Title or Position: MD
Credential:
Phone: 917-628-4987