Provider Demographics
NPI:1205098027
Name:MAXIMUM MOBILITY
Entity type:Organization
Organization Name:MAXIMUM MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:KLOSSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-687-6205
Mailing Address - Street 1:129 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1303
Mailing Address - Country:US
Mailing Address - Phone:607-687-6205
Mailing Address - Fax:607-687-6206
Practice Address - Street 1:129 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1303
Practice Address - Country:US
Practice Address - Phone:607-687-6205
Practice Address - Fax:607-687-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
5582060001Medicare NSC