Provider Demographics
NPI:1144257767
Name:MAYSICK, LAURIE K (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:MAYSICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8275
Mailing Address - Country:US
Mailing Address - Phone:212-889-5477
Mailing Address - Fax:212-889-0517
Practice Address - Street 1:535 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8275
Practice Address - Country:US
Practice Address - Phone:212-889-5477
Practice Address - Fax:212-889-0517
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191387207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01605036Medicaid
NY08J111Medicare PIN
NY01605036Medicaid