# MAXWELL 58 MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578099933
- **Authorized official:** THANIA LOUISOR (INSURANCE DIRECTOR)
- **Authorized official phone:** (212) 952-9355

## Contact information

- **Practice address:** 1441 BROADWAY, SUITE 2403, NEW YORK, NY 10018-1905
- **Practice address phone:** (212) 404-8032
- **Mailing address:** 111 BROADWAY, SUITE 503, NEW YORK, NY 10006-1901
- **Mailing address phone:** (212) 952-9355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 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