=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366704090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXI AIDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2012
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 EXECUTIVE BLVD
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-522-6294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 EXECUTIVE BLVD
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-522-6294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ELLIOT ZARETSKY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 800-522-6294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------