Provider Demographics
NPI:1023351145
Name:MALTIN, LAWRENCE JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOEL
Last Name:MALTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1522
Mailing Address - Country:US
Mailing Address - Phone:516-367-3490
Mailing Address - Fax:516-367-3490
Practice Address - Street 1:102 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1522
Practice Address - Country:US
Practice Address - Phone:516-367-3490
Practice Address - Fax:516-367-3490
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0924862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry