Provider Demographics
NPI:1487607099
Name:MAXIMOS, SAMIR LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:LEWIS
Last Name:MAXIMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:178 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1819
Mailing Address - Country:US
Mailing Address - Phone:201-823-3610
Mailing Address - Fax:201-823-3610
Practice Address - Street 1:1825 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2106
Practice Address - Country:US
Practice Address - Phone:201-547-6117
Practice Address - Fax:201-547-0199
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ60477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6434401Medicaid
NJMA614676Medicare ID - Type Unspecified
NJF96807Medicare UPIN