Provider Demographics
NPI:1104392927
Name:MALAVSKY, DINA (PA)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:
Last Name:MALAVSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4529
Mailing Address - Country:US
Mailing Address - Phone:732-621-4085
Mailing Address - Fax:
Practice Address - Street 1:1203 AVENUE J # 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3669
Practice Address - Country:US
Practice Address - Phone:718-252-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty