Maxana Wilby-Wallace, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F303569 Issued in NY

Practice address

1901 1St Ave
Employees Health Service/Metropolitan Hospital Center
New York, NY 10029-7404

Phone

(212) 423-6384

Fax

(212) 423-8602

NPI assigned

Sep 7, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Metropolitan Medical Practice Plan PC

  • General Practice Physician
  • New York, NY
  • NPI 1306138383
  Medicare reassignment
• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1679587679
  NPD (past)
• Park Avenue Medical Associates, P.C.

  • Geriatric Medicine (Family Medicine) Physician
  • White Plains, NY
  • NPI 1730138645
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189123200000",
    "number": "1174718654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE",
            "address_2": "EMPLOYEES HEALTH SERVICE/METROPOLITAN HOSPITAL CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100297404",
            "telephone_number": "212-423-6384",
            "fax_number": "212-423-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE",
            "address_2": "EMPLOYEES HEALTH SERVICE/METROPOLITAN HOSPITAL CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100297404",
            "telephone_number": "212-423-6384",
            "fax_number": "212-423-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBY-WALLACE",
        "first_name": "MAXANA",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2007-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F303569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Wilbert, DPT
• Michelle Wilbourn
• Emily Anne Wilbur
• Melissa Wilbur
• Rani N Wilburn - Smith, LCSW
• Eric Wilck, MD06291963
• Danielle Nicole Wilcox
• Diana Wilcox, DSW
• Jessica Alice Wilcox
• Tanya Wilcox

• Adult Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.