Provider Demographics
NPI:1043621352
Name:MAITI, SUTAPA (MD)
Entity type:Individual
Prefix:DR
First Name:SUTAPA
Middle Name:
Last Name:MAITI
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 1:228 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2714
Mailing Address - Country:US
Mailing Address - Phone:818-599-2469
Mailing Address - Fax:
Practice Address - Street 1:228 LINDEN LN
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-2714
Practice Address - Country:US
Practice Address - Phone:818-599-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital