Provider Demographics
NPI:1336491786
Name:MALECKI, MARIANNE CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:CHRISTINE
Last Name:MALECKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:CHRISTINE
Other - Last Name:MOEHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 UNION AVE
Mailing Address - Street 2:SUITE 809
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 UNION AVE
Practice Address - Street 2:SUITE 809
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1843
Practice Address - Country:US
Practice Address - Phone:315-477-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016120363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical