Active NPI
Marvin Maisonave, MD
- Emergency Medicine Physician
- Bath, NY
National Provider Identifier
1801095294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 160089-1
- Practice address
- 7571 State Route 54
Bath, NY 14810-9504 - Phone
- (315) 589-9657
- Fax
- (315) 589-9406
- NPI assigned
- Jul 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 160089-1 | NY | Primary |
Addresses
Primary practice location
7571 State Route 54
Bath, NY 14810-9504
Mailing address
3388 Ridge Rd
Williamson, NY 14589-9352
Phone (315) 589-9657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160089-1 | NY | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184544000000",
"number": "1801095294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3388 RIDGE RD",
"city": "WILLIAMSON",
"state": "NY",
"postal_code": "145899352",
"telephone_number": "315-589-9657",
"fax_number": "315-589-9406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7571 STATE ROUTE 54",
"city": "BATH",
"state": "NY",
"postal_code": "148109504",
"telephone_number": "315-589-9657",
"fax_number": "315-589-9406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAISONAVE",
"first_name": "MARVIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-16",
"last_updated": "2007-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "160089-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bath, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.