Provider Demographics
NPI:1922364884
Name:MALTESE, KAREN J (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:J
Last Name:MALTESE
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:805 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1811
Mailing Address - Country:US
Mailing Address - Phone:631-786-3169
Mailing Address - Fax:631-239-6774
Practice Address - Street 1:337 DEER PARK RD
Practice Address - Street 2:SUNRISE DIX HILLS
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5203
Practice Address - Country:US
Practice Address - Phone:631-786-3169
Practice Address - Fax:631-239-6774
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010989-1225100000X, 2251G0304X, 2251S0007X, 2251X0800X
NY010989-012251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQT0481Medicare PIN