Healthcare Provider Details

I. General information

NPI: 1316143480
Provider Name (Legal Business Name): LAWRENCE MAAYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 SHAKESPEARE AVE
BRONX NY
10452-1851
US

IV. Provider business mailing address

270 GREENWICH AVE
GREENWICH CT
06830-6530
US

V. Phone/Fax

Practice location:
  • Phone: 713-732-7080
  • Fax: 718-732-7090
Mailing address:
  • Phone: 203-559-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number040591
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number215812
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD466425
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: