Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | MD00116400 | NJ |
NPI | 1053412338 |
---|---|
Provider Name | Raymond M. Maimone |
First Address | Fairview, NJ 07022-2071 |
Second Address | Fairview, NJ 07022-2071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 23/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1613006 | (05) | NJ |
T77750 | (02) | NJ |