MEDICARE: DR. TODD JOSEPH MALTESE D.O.

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	2084N0400X	Neurology Physician	265409	NY
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	265409	NY
3	2084N0600X	Clinical Neurophysiology Physician	265409	NY

General Provider Information

NPI Number	:	1255521456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD JOSEPH MALTESE D.O.

Provider Business Mailing Address
First Line	:	650 HAWKINS AVE
Second Line	:	SUITE 7
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-2366
Country	:	US
Telephone Number	:	631-737-0055
Fax Number	:	631-737-0076

Provider Business Practice Location Address
First Line	:	650 HAWKINS AVE
Second Line	:	SUITE 7
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-2366
Country	:	US
Telephone Number	:	631-737-0055
Fax Number	:	631-737-0076

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

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	03/27/2015

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