Maverick Family Medical, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

142652 Issued in NY

Legal business name

MAVERICK FAMILY MEDICAL, PC

Practice address

404 Zena Rd
Woodstock, NY 12498

Phone

(845) 679-5271

Fax

(845) 679-0726

NPI assigned

Jan 26, 2006

Organization subpart

No

Name

Dr. Randall Sidney Rissman, M.D.

Title

President

Phone

(845) 679-5271

• MAVERICK FAMILY HEALTH Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 3, 2010.

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272844800000",
    "number": "1891765244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 ZENA RD",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "12498",
            "telephone_number": "845-679-5271",
            "fax_number": "845-679-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 ZENA RD",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "12498",
            "telephone_number": "845-679-5271",
            "fax_number": "845-679-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK FAMILY MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2010-05-03",
        "status": "A",
        "authorized_official_last_name": "RISSMAN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "SIDNEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-679-5271",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "142652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01907313",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTIN",
            "identifier": "1213350001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAVERICK FAMILY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Hammel, PH.D., Psychologist, P.C.
• Mallory Markman
• Nancy Mastrocola, FNP
• Maverick Family Counseling
• Maverick Family Counseling LCSW PLLC
• Megan McCambley, MHC-LP
• James Jordan McErlean
• Medical Associates of the Hudson Valley
• Monica Ruth Meyer, MD
• William Fred Milton, D.M.D

• All providers in Woodstock, NY
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; 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.