Provider Demographics
NPI:1699051573
Name:MAXIBRACE
Entity type:Organization
Organization Name:MAXIBRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-889-1500
Mailing Address - Street 1:16 MCCARTHY RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1111
Mailing Address - Country:US
Mailing Address - Phone:516-889-1500
Mailing Address - Fax:516-889-1253
Practice Address - Street 1:16 MCCARTHY RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1111
Practice Address - Country:US
Practice Address - Phone:516-889-1500
Practice Address - Fax:516-889-1253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDESMAN BROS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies