Provider Demographics
NPI:1609062512
Name:E. MARTIN MAIDA, M.D.,PA
Entity type:Organization
Organization Name:E. MARTIN MAIDA, M.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-535-2734
Mailing Address - Street 1:209 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4044
Mailing Address - Country:US
Mailing Address - Phone:973-535-6266
Mailing Address - Fax:973-535-2810
Practice Address - Street 1:209 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4044
Practice Address - Country:US
Practice Address - Phone:973-535-6266
Practice Address - Fax:973-535-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04942800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4715OtherRAILROAD MEDICARE
050993Medicare PIN