Provider Demographics
NPI:1063683076
Name:MALVAL, PHOEBE (NP)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:MALVAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 LENOX RD
Mailing Address - Street 2:APT 6R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2023
Mailing Address - Country:US
Mailing Address - Phone:347-529-0009
Mailing Address - Fax:
Practice Address - Street 1:440 LENOX RD
Practice Address - Street 2:APT 6R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2023
Practice Address - Country:US
Practice Address - Phone:347-529-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335422-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily