Basic Information
| Provider Information | |||||||||
| NPI: | 1114936242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAISEL | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 CROSSWAYS PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169383000 | ||||||||
| FaxNumber: | 5169383239 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 CROSSWAYS PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169383000 | ||||||||
| FaxNumber: | 5169383239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 166949-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01371264 | 05 | NY | MEDICAID | 30F52 | 01 | NY | BCBS | OTHER |