Maxwell Tyler Anderson, ATC/LAT, OPE-C

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

003185 Issued in NY

Practice address

1985 Crompond Rd BLDG E
Cortlandt Manor, NY 10567-4146

Phone

(914) 233-3022

Fax

(914) 402-1194

NPI assigned

Dec 12, 2023

Last updated

Dec 12, 2023By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1702339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1629846472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 CROMPOND RD BLDG E",
            "city": "CORTLANDT MANOR",
            "state": "NY",
            "postal_code": "105674146",
            "telephone_number": "914-233-3022",
            "fax_number": "914-402-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 CROMPOND RD BLDG E",
            "city": "CORTLANDT MANOR",
            "state": "NY",
            "postal_code": "105674146",
            "telephone_number": "914-233-3022",
            "fax_number": "914-402-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MAXWELL",
        "middle_name": "TYLER",
        "credential": "ATC/LAT, OPE-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-12",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "003185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Alvarez, MD
• Nadia Naz Amin, M.D.
• Emmanuel Amoyaw Jr.
• Ananda Seva Medical PC
• Pavan Kumar Ananth, M.D.
• Catherine Anesi, LCSW
• Alison Jill Angelini, MA CCC-SLP
• Maridanielle D. Annicchiarico, PA
• Jessica Anson, LMSW
• Antonio Petruzzo, MD., PC.

• Athletic Trainer in Cortlandt Manor, NY
• Providers in Cortlandt Manor, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.