Provider Demographics
NPI:1255521456
Name:MALTESE, TODD JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JOSEPH
Last Name:MALTESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 HAWKINS AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2366
Mailing Address - Country:US
Mailing Address - Phone:631-737-0055
Mailing Address - Fax:631-737-0076
Practice Address - Street 1:650 HAWKINS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2366
Practice Address - Country:US
Practice Address - Phone:631-737-0055
Practice Address - Fax:631-737-0076
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2654092084N0400X, 2084S0012X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology