MEDICARE: MAXIM OF NEW YORK, LLC

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	251E00000X	Home Health Agency	1121L003	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265543706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM OF NEW YORK, LLC

Provider Business Mailing Address
First Line	:	7227 LEE DEFOREST RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 STATE ST STE 300
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14614-1353
Country	:	US
Telephone Number	:	585-484-3550
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	DAVID KOWALCZYK
Credential	:
Telephone Number	:	410-910-1500

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/24/2019

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Directions to “MAXIM OF NEW YORK, LLC ” Practice Location

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