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Organization
MAXWELL 58 MEDICAL PC
Active
Organization
MAXWELL 58 MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THANIA LOUISOR (INSURANCE DIRECTOR)
(212) 952-9355
Entity
Organization
Contact information
Practice address
1441 BROADWAY, SUITE 2403, NEW YORK, NY 10018-1905
(212) 404-8032
Mailing address
111 BROADWAY, SUITE 503, NEW YORK, NY 10006-1901
(212) 952-9355
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
171100000X
Acupuncturist
—
NULL
171100000X
Acupuncturist
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Enumeration date
05/04/2017
Last updated
05/30/2024
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