=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508840174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ALBERT MAIORINO JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MONTAUK HWY GOOD SAMARITAN HOSPITAL
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795-4927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-376-4088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 BOYLE RD
-----------------------------------------------------
City | SELDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11784-4030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-736-4064
-----------------------------------------------------
Fax | 631-736-1332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 186588
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------