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General NPI Number Information
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NPI Number | 1578345807
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Entity Type | Organization
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Legal Business Name | MAISIE SERVICES, LLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 3902 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2776
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Country | US
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Telephone | 347-225-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 63 BUSH AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-2215
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Country | US
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Telephone | 347-679-9566
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RANDY YHAP JR.
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Credential |
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Telephone | 347-679-9566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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