Provider Demographics
NPI:1447450382
Name:AIN, MAXINE JUNE (MD)
Entity type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:JUNE
Last Name:AIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1440
Mailing Address - Country:US
Mailing Address - Phone:718-876-7716
Mailing Address - Fax:718-876-7761
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1440
Practice Address - Country:US
Practice Address - Phone:718-876-7716
Practice Address - Fax:718-876-7761
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY142437-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
COPENDINGMedicaid
NMPENDINGMedicaid
PENDINGMedicare Oscar/Certification