Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 166672 | NY |
NPI | 1700926466 |
---|---|
Provider Name | Dr. Mario John Malvarosa |
First Address | Hopewell Junction, NY 12533-5719 |
Second Address | Fishkill, NY 12524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |