Provider Demographics
NPI:1417566258
Name:MALONEY, NEZIAH
Entity Type:Individual
Prefix:
First Name:NEZIAH
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2345
Mailing Address - Country:US
Mailing Address - Phone:347-867-3124
Mailing Address - Fax:
Practice Address - Street 1:43 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2345
Practice Address - Country:US
Practice Address - Phone:347-867-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-09-16
Deactivation Date:2020-08-19
Deactivation Code:
Reactivation Date:2020-09-16
Provider Licenses
StateLicense IDTaxonomies
NY010293156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician