Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 055748 | NY |
NPI | 1003196445 |
---|---|
Provider Name | Dr. Alevtina Malakova |
First Address | Forest Hills, NY 11375-2460 |
Second Address | Elmhurst, NY 11373-5559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 12/11/2019 |