Individual
MS. MAIA MAMAMTAVRISHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
212 W 71ST ST, SUITE#3, NEW YORK, NY 10023-3725
(917) 815-0434
(718) 862-4862
Mailing address
15900 RIVERSIDE DR W, 3G70, NEW YORK, NY 10032-1004
(212) 543-9395
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
234336
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234336
—
NY
Enumeration date
03/20/2007
Last updated
05/29/2009
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