NPIMap

Organization Active NPI

Maxim of New York, LLC

  • Home Health Agency
  • Syracuse, NY
National Provider Identifier
1639280100
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1121L002 Issued in NY
Legal business name
MAXIM OF NEW YORK, LLC
Practice address
1011 W Genesee St Ste 3
Syracuse, NY 13204-2329
Phone
(315) 476-0600
NPI assigned
Aug 31, 2006
Organization subpart
Yes
Parent organization
MAXIM HEALTHCARE SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2019

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

Authorized official

Name
David Kowalczyk
Title
VP of Finance
Phone
(410) 910-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1121L002 NY Primary

Addresses

Primary practice location

1011 W Genesee St Ste 3
Syracuse, NY 13204-2329

Mailing address

7227 Lee Deforest Dr
Columbia, MD 21046-3236
Phone (410) 910-1500

Other practice location 1

224 Harrison St
Suite 680
Syracuse, NY 13202-3056
Phone (315) 476-0600

Other identifiers 2

IdentifierTypeStateIssuer
0232438504MedicaidNY
02621396-004MedicaidNY

Other names 1

  • Maxim Healthcare Services, Inc. Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1056319Maxim of New York LLC1011 W Genesee St - Suite 3, Syracuse, NY 13204Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Maxim Healthcare Services12 organizations share this tax ID, including this one
Part of
Maxim Healthcare Servise

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

224 Harrison St
Ste 680
Syracuse, NY 13202
Phone (315) 476-6000

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569283200000",
    "number": "1639280100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 LEE DEFOREST DR",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463236",
            "telephone_number": "410-910-1500",
            "fax_number": "410-910-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 W GENESEE ST STE 3",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042329",
            "telephone_number": "315-476-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "224 Harrison St",
            "address_2": "Suite 680",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132023056",
            "country_code": "US",
            "telephone_number": "315-476-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXIM OF NEW YORK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAXIM HEALTHCARE SERVICES, INC.",
        "enumeration_date": "2006-08-31",
        "last_updated": "2019-09-24",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "410-910-1500"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "1121L002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0232438504",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02621396-004",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maxim Healthcare Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maxim Healthcare Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.