Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 097340-1 | NY |
NPI | 1124057377 |
---|---|
Provider Name | Jack Maidman |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B13111 | (02) | NY |