NPIMap

Organization Active NPI

Maxim of New York, LLC

  • Home Health Agency
  • Westbury, NY
National Provider Identifier
1750493706
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1121L006 Issued in NY
Legal business name
MAXIM OF NEW YORK, LLC
Practice address
900 Merchants Concourse Ste LL06
Westbury, NY 11590
Phone
(516) 565-6322
NPI assigned
Aug 31, 2006
Last updated
Sep 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

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 1121L006 NY Primary

Addresses

Primary practice location

900 Merchants Concourse Ste LL06
Westbury, NY 11590

Mailing address

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

Other practice location 1

900 Merchants Concourse
Suite 216
Westbury, NY 11590-5142
Phone (516) 565-6322

Other practice location 2

900 Merchants Concourse Ste Ll06
Westbury, NY 11590-5144
Phone (516) 565-6322

Other identifiers 3

IdentifierTypeStateIssuer
023243851009MedicaidNY
03011098-013MedicaidNY
02621396-008MedicaidNY

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
33D0992383Maxim of New York LLC900 Merchants Concourse - Ste 412, Westbury, NY 11590Certificate of waiverMar 26, 2027

National Provider Directory

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

Other organizations with this tax ID 11

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

Locations

900 Merchants Concourse
Ste 216
Westbury, NY 11590
Phone (516) 565-6322

900 Merchants Concourse
Ste LL06
Westbury, NY 11590
Phone (516) 565-6322

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1536192000000",
    "number": "1750493706",
    "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": "900 MERCHANTS CONCOURSE STE LL06",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "11590",
            "telephone_number": "516-565-6322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Merchants Concourse",
            "address_2": "Suite 216",
            "address_purpose": "LOCATION",
            "city": "Westbury",
            "state": "NY",
            "postal_code": "115905142",
            "country_code": "US",
            "telephone_number": "516-565-6322",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 Merchants Concourse Ste Ll06",
            "address_purpose": "LOCATION",
            "city": "Westbury",
            "state": "NY",
            "postal_code": "115905144",
            "country_code": "US",
            "telephone_number": "516-565-6322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXIM OF NEW YORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-09-06",
        "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": "1121L006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023243851009",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03011098-013",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02621396-008",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbury, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; 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.