Provider Demographics
NPI:1881745602
Name:ANTO, CECILY MALIAKAL (MD)
Entity type:Individual
Prefix:DR
First Name:CECILY
Middle Name:MALIAKAL
Last Name:ANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ROUTE 111
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4370
Mailing Address - Country:US
Mailing Address - Phone:631-724-4455
Mailing Address - Fax:631-724-4490
Practice Address - Street 1:521 ROUTE 111
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4370
Practice Address - Country:US
Practice Address - Phone:631-724-4455
Practice Address - Fax:631-724-4490
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1453532084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12105Medicare UPIN