Provider Demographics
NPI:1366440679
Name:MALPESO, JAMES V (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:MALPESO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-9600
Mailing Address - Fax:718-226-7891
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:STE 302
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9600
Practice Address - Fax:718-226-7891
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127329207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00486195Medicaid
NY28A021Medicare ID - Type Unspecified
B12129Medicare UPIN