Provider Demographics
NPI:1497740542
Name:MALINOWSKI, JILL C (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 METROPOLITAN PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-7112
Mailing Address - Country:US
Mailing Address - Phone:315-870-9369
Mailing Address - Fax:315-870-9364
Practice Address - Street 1:5100 W TAFT RD STE 4D
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3810
Practice Address - Country:US
Practice Address - Phone:315-458-6669
Practice Address - Fax:315-299-5983
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY333731363LF0000X
NYF333731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02406742Medicaid