Maia Mamamtavrishvili, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

234336 Issued in NY

Practice address

212 W 71St St
Suite#3
New York, NY 10023-3725

Phone

(917) 815-0434

Fax

(718) 862-4862

NPI assigned

Mar 20, 2007

Last updated

May 29, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243555200000",
    "number": "1700901600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15900 RIVERSIDE DR W",
            "address_2": "3G70",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321004",
            "telephone_number": "212-543-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W 71ST ST",
            "address_2": "SUITE#3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100233725",
            "telephone_number": "917-815-0434",
            "fax_number": "718-862-4862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMAMTAVRISHVILI",
        "first_name": "MAIA",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "234336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher J Malynowski, PA
• Aleksandra Malz
• Gregory Malzberg
• Laurence Jay Malzberg, RPA-C
• Mama Glow LLC
• Daniel Yaron Maman, M.D.
• Yair Maman, PHD DPSYCH
• Mimon Yehuda Mamane, LCSW
• Andrea Mamani, MSPT
• Mandi M Mamanna

• Psychiatry Physician in New York, NY
• Providers in New York, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; 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.
• 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.