Provider Demographics
NPI:1497723878
Name:MALAK, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MALAK
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 1:207 WASHINGTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-8111
Mailing Address - Country:US
Mailing Address - Phone:845-249-2510
Mailing Address - Fax:845-249-2505
Practice Address - Street 1:207 WASHINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-8111
Practice Address - Country:US
Practice Address - Phone:845-249-2510
Practice Address - Fax:845-249-2505
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY15935912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01160503Medicaid