Provider Demographics
NPI:1407139231
Name:MALAMEN, FIONA V (LMT)
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:V
Last Name:MALAMEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4470
Mailing Address - Country:US
Mailing Address - Phone:845-331-0300
Mailing Address - Fax:845-331-1130
Practice Address - Street 1:324 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4470
Practice Address - Country:US
Practice Address - Phone:845-331-0300
Practice Address - Fax:845-331-1130
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist