Provider Demographics
NPI:1538141312
Name:MALENKY, EDA M (RN,MS,CS)
Entity Type:Individual
Prefix:MS
First Name:EDA
Middle Name:M
Last Name:MALENKY
Suffix:
Gender:F
Credentials:RN,MS,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3119
Mailing Address - Country:US
Mailing Address - Phone:718-783-4076
Mailing Address - Fax:
Practice Address - Street 1:861 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3119
Practice Address - Country:US
Practice Address - Phone:718-783-4076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282329163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR15981Medicare ID - Type Unspecified