Provider Demographics
NPI:1053412338
Name:MAIMONE, RAYMOND M (DPM)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:M
Last Name:MAIMONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-2071
Mailing Address - Country:US
Mailing Address - Phone:201-941-5003
Mailing Address - Fax:201-941-3903
Practice Address - Street 1:89 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-2071
Practice Address - Country:US
Practice Address - Phone:201-941-5003
Practice Address - Fax:201-941-3903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00116400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1613006Medicaid
NJT77750Medicare UPIN
NJ1613006Medicaid