=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184326621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIM BRAIN AND SPINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 11/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 197 RIDGEDALE AVE STE 225
-----------------------------------------------------
City | CEDAR KNOLLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07927-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-206-1477
-----------------------------------------------------
Fax | 973-695-1645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 197 RIDGEDALE AVE STE 225
-----------------------------------------------------
City | CEDAR KNOLLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07927-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-206-1477
-----------------------------------------------------
Fax | 973-695-1645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. SCOTT ANDREW MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-628-4987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------