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General NPI Number Information
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NPI Number | 1871784504
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Entity Type | Organization
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Legal Business Name | MAXIM KREDITOR MD PC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 380 2ND AVENUE SUITE 1003
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City | NEW YORK
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State | NY
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Zip | 10010
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Country | US
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Telephone | 212-448-9555
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Fax | 212-448-0999
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Provider Business Mailing Address
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Address Line | 380 2ND AVE SUITE 1003
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City | NEW YORK
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State | NY
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Zip | 10010-5615
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Country | US
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Telephone | 212-448-9555
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Fax | 212-448-0999
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Authorized Official
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Title or Position | MD/OWNER
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Name | MAXIM KREDITOR
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Credential | M.D.
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Telephone | 212-448-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 216136
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License Number State | NY
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