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Organization
MAVERICK FAMILY MEDICAL, PC
Active
Organization
MAVERICK FAMILY MEDICAL, PC
Active
Other names
Maverick Family Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN DAVID KRAKOWER MD (VICE PRESIDENT)
(845) 657-7820
Entity
Organization
Contact information
Practice address
4080 STATE ROUTE 28 STE 1, BOICEVILLE, NY 12412-5129
(845) 657-7820
(845) 657-6016
Mailing address
4080 STATE ROUTE 28 STE 1, BOICEVILLE, NY 12412-5129
(845) 657-7820
(845) 657-6016
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01907313
—
NY
Enumeration date
03/07/2012
Last updated
03/07/2012
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