Provider Demographics
NPI:1902290869
Name:TODD J. MALTESE, D.O., P.C.
Entity type:Organization
Organization Name:TODD J. MALTESE, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALTESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-737-0055
Mailing Address - Street 1:650 HAWKINS AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2366
Mailing Address - Country:US
Mailing Address - Phone:631-737-0055
Mailing Address - Fax:631-737-0076
Practice Address - Street 1:650 HAWKINS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2366
Practice Address - Country:US
Practice Address - Phone:631-737-0055
Practice Address - Fax:631-737-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2654092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A900114711Medicare PIN