Provider Demographics
NPI:1164943395
Name:DR. PHILLIP MALVASI D.O. LLC
Entity Type:Organization
Organization Name:DR. PHILLIP MALVASI D.O. LLC
Other - Org Name:PHILLIP MALVASI D.O.L L C
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MALVASI DO LLC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-544-5600
Mailing Address - Street 1:1017 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4620
Mailing Address - Country:US
Mailing Address - Phone:330-544-5600
Mailing Address - Fax:330-544-5550
Practice Address - Street 1:1017 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4620
Practice Address - Country:US
Practice Address - Phone:330-544-5600
Practice Address - Fax:330-544-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty