MEDICARE: MAXWELL ODOI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	306332	NY

General Provider Information

NPI Number	:	1003334749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL ODOI

Provider Business Mailing Address
First Line	:	3478 CORSA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1829
Country	:	US
Telephone Number	:	646-427-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	3478 CORSA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1829
Country	:	US
Telephone Number	:	646-427-4129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	07/21/2022

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Directions to “ MAXWELL ODOI ” Practice Location

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