MEDICARE: MAPLE PEDIATRICS NY

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1174454854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE PEDIATRICS NY

Provider Business Mailing Address
First Line	:	126 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2510
Country	:	US
Telephone Number	:	917-841-8621
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DESPINA TSEVDOS
Credential	:	MD
Telephone Number	:	917-725-0787

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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