Provider Demographics
NPI:1164686713
Name:SAM T MALKIN DDS, L.L.P.
Entity Type:Organization
Organization Name:SAM T MALKIN DDS, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-796-6588
Mailing Address - Street 1:64 DIVISION AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2999
Mailing Address - Country:US
Mailing Address - Phone:516-796-6588
Mailing Address - Fax:516-796-6749
Practice Address - Street 1:64 DIVISION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2999
Practice Address - Country:US
Practice Address - Phone:516-796-6588
Practice Address - Fax:516-796-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty