Provider Demographics
NPI:1376844282
Name:SULLIVAN-MALONEY, MAURA PEGEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:PEGEEN
Last Name:SULLIVAN-MALONEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-40 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4016
Mailing Address - Country:US
Mailing Address - Phone:718-784-2240
Mailing Address - Fax:
Practice Address - Street 1:41-40 27TH STREET
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-784-2240
Practice Address - Fax:914-965-4724
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03558707Medicaid