Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME107408 | FL |
Y | 2080P0201X | Pediatric Allergist | ME107408 | FL |
NPI | 1558532275 |
---|---|
Provider Name | Jonathan M Malka |
First Address | Plantation, FL 33324-3920 |
Second Address | North Miami, FL 33181-2817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 23/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003703500 | (05) | FL |
27608875 | (05) | CO |