| Doctor Name: | DR. JOHN R MAESE |
| NPI Number: | 1750476289 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 171607 |
| Business Practice Address: | 420 Lyndale Avenue Staten Island, NY - 10312 |
| Business Phone Number: | 7189675630 |
| Business Fax Number: | 7189677099 |
| Mailing Address: | 420 Lyndale Avenue, STATEN ISLAND |
| State: | NY |
| Postal Code: | 10312 |
| Phone Number: | 7189675630 |
| Fax Number: | 7189677099 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 05/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 171607 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |