Provider Demographics
NPI:1568402261
Name:MALACHOVSKY, MARTIN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:MALACHOVSKY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WEST 58TH STREET
Mailing Address - Street 2:SUITE 414
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:917-664-5607
Mailing Address - Fax:212-875-8261
Practice Address - Street 1:330 WEST 58TH STREET
Practice Address - Street 2:SUITE 414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:888-603-9338
Practice Address - Fax:212-624-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01857152Medicaid
NY37N891Medicare PIN
NYG73029Medicare UPIN
NY01857152Medicaid