Provider Demographics
NPI:1518214212
Name:MALKIN, SVETLANA (DPT)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:MALKIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3622
Mailing Address - Country:US
Mailing Address - Phone:646-416-1056
Mailing Address - Fax:
Practice Address - Street 1:1000 US HIGHWAY 9 N
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1215
Practice Address - Country:US
Practice Address - Phone:646-416-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01441000225100000X
NY62034769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist