Provider Demographics
NPI:1386762755
Name:MAXIMOFF, TANYA MARIA (DC)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIA
Last Name:MAXIMOFF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAIN STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-292-0222
Mailing Address - Fax:973-575-8595
Practice Address - Street 1:250 MAIN STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-292-0222
Practice Address - Fax:973-236-0034
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00585000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083733Medicare ID - Type Unspecified