Healthcare Provider Details

I. General information

NPI: 1144154105
Provider Name (Legal Business Name): MAITIN PHYSIATRY AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WOODCREST AVE
SHORT HILLS NJ
07078-2149
US

IV. Provider business mailing address

51 WOODCREST AVE
SHORT HILLS NJ
07078-2149
US

V. Phone/Fax

Practice location:
  • Phone: 516-220-2881
  • Fax:
Mailing address:
  • Phone: 516-220-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA ASHLEY MAITIN
Title or Position: PHYSICIAN
Credential: DO
Phone: 516-220-2881