Individual
MAXIM KREDITOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
380 SECOND AVENUE, SUITE 1003, NEW YORK, NY 10010-4616
(212) 448-9555
(212) 448-0999
Mailing address
380 2ND AVE, SUITE 1003, NEW YORK, NY 10010-5615
(212) 448-9555
(212) 448-0999
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
216136
NY
207RH0003X
Hematology & Oncology Physician
216136
NY
207RX0202X
Medical Oncology Physician
Primary
216136
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02568638
—
NY
Enumeration date
06/07/2006
Last updated
10/24/2025
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