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General NPI Number Information
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NPI Number | 1811901630
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Entity Type | Organization
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Legal Business Name | MAPLE MEDICAL, LLP
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 170 MAPLE AVE SUITE G1
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4710
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Country | US
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Telephone | 914-328-0932
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Fax | 914-328-9851
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Provider Business Mailing Address
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Address Line | 170 MAPLE AVE SUITE G1
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4710
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Country | US
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Telephone | 914-328-0932
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Fax | 914-328-9851
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Authorized Official
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Title or Position | DIRECTOR LABORATORY
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Name | DR. LOUIS DOMINICK VIZIOLI
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Credential | M.D.
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Telephone | 914-328-0932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 33D0726624
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License Number State | NY
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