Provider Demographics
NPI:1477952513
Name:MALSKY, RANDOLPH (PHD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:MALSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SUNRISE HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2598
Mailing Address - Country:US
Mailing Address - Phone:631-956-7337
Mailing Address - Fax:
Practice Address - Street 1:150 SUNRISE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-956-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7802103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist