Healthcare Provider Details

I. General information

NPI: 1720582430
Provider Name (Legal Business Name): HEATHER LYNN MAIOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 1ST AVE
NEW YORK NY
10016-6419
US

IV. Provider business mailing address

520 1ST AVE
NEW YORK NY
10016-6419
US

V. Phone/Fax

Practice location:
  • Phone: 212-447-2030
  • Fax:
Mailing address:
  • Phone: 212-447-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number317067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: