Provider Demographics
NPI:1528223021
Name:MALPESO, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MALPESO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3419
Mailing Address - Country:US
Mailing Address - Phone:718-663-6400
Mailing Address - Fax:718-663-6490
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3419
Practice Address - Country:US
Practice Address - Phone:718-663-6400
Practice Address - Fax:718-663-6490
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101142207RC0000X
NY245600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease