Provider Demographics
NPI:1982203063
Name:MALTZ, NILTON (MSC, LP)
Entity Type:Individual
Prefix:
First Name:NILTON
Middle Name:
Last Name:MALTZ
Suffix:
Gender:M
Credentials:MSC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 OCEAN AVE APT 3K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2011
Mailing Address - Country:US
Mailing Address - Phone:631-835-9737
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE RM 1210
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5025
Practice Address - Country:US
Practice Address - Phone:401-589-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1081102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst