Healthcare Provider Details

I. General information

NPI: 1447399340
Provider Name (Legal Business Name): DR. ROBERT MAIMONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 16TH ST APT LL
NEW YORK NY
10003-3790
US

IV. Provider business mailing address

205 E 16TH ST APT LL
NEW YORK NY
10003-3790
US

V. Phone/Fax

Practice location:
  • Phone: 212-228-2505
  • Fax:
Mailing address:
  • Phone: 212-228-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number37188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: