Provider Demographics
NPI:1467894576
Name:DEGANI, MALKA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:
Last Name:DEGANI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:MALKA
Other - Middle Name:
Other - Last Name:WILLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 DYKSTRAS WAY EAST
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-356-0743
Mailing Address - Fax:
Practice Address - Street 1:58 DYKSTRAS WAY E
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-4025
Practice Address - Country:US
Practice Address - Phone:845-356-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY859981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEM06707HMedicaid