Provider Demographics
NPI:1417026394
Name:ANTO, MALIAKAL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MALIAKAL
Middle Name:JOSEPH
Last Name:ANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-496-7900
Mailing Address - Fax:516-496-2139
Practice Address - Street 1:8 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-496-7900
Practice Address - Fax:516-496-2139
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141007207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00649610Medicaid
NY056A791Medicare ID - Type Unspecified
D47757Medicare UPIN