Provider Demographics
NPI:1497795983
Name:MALAKOVA, NATALYA (OD)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:MALAKOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 YELLOWSTONE BLVD
Mailing Address - Street 2:SUITE CF-103
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1530
Mailing Address - Country:US
Mailing Address - Phone:718-830-0201
Mailing Address - Fax:718-830-0206
Practice Address - Street 1:6405 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE CF-103
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1530
Practice Address - Country:US
Practice Address - Phone:718-830-0201
Practice Address - Fax:718-830-0206
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02162229Medicaid
NY05527GMedicare PIN
NYU86830Medicare UPIN