MEDICARE: IAN B MAITIN MD

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	208100000X	Physical Medicine & Rehabilitation Physician	25MA05556000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306834502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN B MAITIN MD

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-566-7010
Fax Number	:	856-566-6956

Provider Business Practice Location Address
First Line	:	42 E LAUREL RD STE 1700
Second Line	:
City	:	STRATFORD
State	:	NJ
Zip	:	08084-1354
Country	:	US
Telephone Number	:	856-566-7010
Fax Number	:	856-566-6956

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	09/10/2025

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Directions to “ IAN B MAITIN MD” Practice Location

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