Provider Demographics
NPI:1417992504
Name:MALETZKE, MARTA (NP)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:
Last Name:MALETZKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HIGH TECH DR
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:NY
Mailing Address - Zip Code:14543-9746
Mailing Address - Country:US
Mailing Address - Phone:585-334-0130
Mailing Address - Fax:585-334-0213
Practice Address - Street 1:15 HIGH TECH DR
Practice Address - Street 2:
Practice Address - City:RUSH
Practice Address - State:NY
Practice Address - Zip Code:14543-9746
Practice Address - Country:US
Practice Address - Phone:585-334-0130
Practice Address - Fax:585-334-0213
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP0369OtherPREFERRED CARE
NYP019330243OtherBLUE CHOICE
NYBB7683Medicare PIN
NYP019330243OtherBLUE CHOICE