MEDICARE: MR. MARTIN S MALTZ RPH

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	183500000X	Pharmacist	055413	NY

General Provider Information

NPI Number	:	1740499318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN S MALTZ RPH

Provider Business Mailing Address
First Line	:	1751 E 32ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4441
Country	:	US
Telephone Number	:	718-339-1181
Fax Number	:

Provider Business Practice Location Address
First Line	:	4624 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2545
Country	:	US
Telephone Number	:	718-436-9300
Fax Number	:	718-854-6116

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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