Healthcare Provider Details

I. General information

NPI: 1174454854
Provider Name (Legal Business Name): MAPLE PEDIATRICS NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 56TH ST
BROOKLYN NY
11220-2510
US

IV. Provider business mailing address

126 56TH ST
BROOKLYN NY
11220-2510
US

V. Phone/Fax

Practice location:
  • Phone: 917-841-8621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DESPINA TSEVDOS
Title or Position: OWNER
Credential: MD
Phone: 917-725-0787