Provider Demographics
NPI:1003886946
Name:MALTIN, ELIZABETH P (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:P
Last Name:MALTIN
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:150 E SUNRISE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2598
Mailing Address - Country:US
Mailing Address - Phone:631-225-7200
Mailing Address - Fax:631-225-4565
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-225-7200
Practice Address - Fax:631-225-4565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1916692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01870846Medicaid
NY01870846Medicaid
NYG46092Medicare UPIN