Provider Demographics
NPI:1609952076
Name:MARITATO, MARIA SUSANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SUSANA
Last Name:MARITATO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:612 74TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3324
Mailing Address - Country:US
Mailing Address - Phone:718-963-5808
Mailing Address - Fax:718-963-8753
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-5808
Practice Address - Fax:718-963-8753
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY191535207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01605054Medicaid
NY01605054Medicaid