MEDICARE: DR. SAMEL MALDONADO PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1699120568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMEL MALDONADO PH.D

Provider Business Mailing Address
First Line	:	555 NORTH AVE
Second Line	:	#22D
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2404
Country	:	US
Telephone Number	:	201-410-7376
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 NORTH AVE
Second Line	:	#22D
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2404
Country	:	US
Telephone Number	:	201-364-8474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	04/28/2016

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