Provider Demographics
NPI:1497801666
Name:MALITSKY, IGOR (CPED)
Entity Type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:MALITSKY
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SHUNPIKE RD STE 41
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2497
Mailing Address - Country:US
Mailing Address - Phone:860-635-7653
Mailing Address - Fax:860-635-2080
Practice Address - Street 1:51 SHUNPIKE RD STE 41
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2497
Practice Address - Country:US
Practice Address - Phone:860-635-7653
Practice Address - Fax:860-635-2080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20361222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist