=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437070240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAINE PERFORMANCE AND LONGEVITY CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2026
-----------------------------------------------------
Last Update Date | 07/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 586 MAIN RD N STE A
-----------------------------------------------------
City | HAMPDEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04444-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-356-5222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 BOWEN DR
-----------------------------------------------------
City | HAMPDEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04444-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-356-5222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER AND OWNER
-----------------------------------------------------
Name | MR. ZACHARY MITCHELL GREENIER
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 207-356-5222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------