Provider Demographics
NPI:1962813212
Name:MALONEY, MAUREEN FRANCIS
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN FRANCIS
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4912
Mailing Address - Country:US
Mailing Address - Phone:516-884-4160
Mailing Address - Fax:631-830-6140
Practice Address - Street 1:11 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4912
Practice Address - Country:US
Practice Address - Phone:516-884-4160
Practice Address - Fax:631-830-6140
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY88888171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88888Medicaid