Healthcare Provider Details

I. General information

NPI: 1497858674
Provider Name (Legal Business Name): THOMAS M MALTESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MADISON ST. HUTCHINGS PSYCHIATRIC CENTER
SYRACUSE NY
13210-1811
US

IV. Provider business mailing address

5109 HOAG LN
FAYETTEVILLE NY
13066-2506
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-3600
  • Fax: 315-426-6888
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number184595
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: