Individual
MAXIM KREDITOR
Active
Individual
MAXIM KREDITOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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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