Healthcare Provider Details

I. General information

NPI: 1811647290
Provider Name (Legal Business Name): ESTHER MAX FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date: 05/01/2025
Reactivation Date: 06/16/2025

III. Provider practice location address

7119 162ND ST # CF-C
FRESH MEADOWS NY
11365-4444
US

IV. Provider business mailing address

7119 162ND ST # CF-C
FRESH MEADOWS NY
11365-4444
US

V. Phone/Fax

Practice location:
  • Phone: 718-475-0500
  • Fax:
Mailing address:
  • Phone: 718-475-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355963
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83785801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: