Individual
MICHAEL JUDE MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
535 E 70TH ST, NEW YORK, NY 10021-4872
(212) 628-3523
Mailing address
535 E 70TH ST, NEW YORK, NY 10021-4872
(212) 628-3523
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
168756
NY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
168756
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02694062
—
NY
01
—
65268ANX51
MEDICARE PTAN
NY
01
—
WANX51
MEDICARE GROUP NUMBER
NY
Enumeration date
02/23/2006
Last updated
05/09/2008
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