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NPI Code Detail

MEDICARE: MAXIM OF NEW YORK, LLC

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
1251E00000XHome Health Agency1121L002NY

Other Identifiers

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

General Provider Information

NPI Number : 1639280100
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAXIM OF NEW YORK, LLC
Provider Business Mailing Address
First Line : 7227 LEE DEFOREST DR
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3236
Country : US
Telephone Number : 410-910-1500
Fax Number : 410-910-1600
Provider Business Practice Location Address
First Line : 1011 W GENESEE ST STE 3
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2329
Country : US
Telephone Number : 315-476-0600
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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