Provider Demographics
NPI:1578143095
Name:KLUSEK, MALWINA MARIA (DO)
Entity Type:Individual
Prefix:
First Name:MALWINA
Middle Name:MARIA
Last Name:KLUSEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MALVINA
Other - Middle Name:
Other - Last Name:KLUSEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:104 S VILLAGE AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5851
Mailing Address - Country:US
Mailing Address - Phone:917-549-4065
Mailing Address - Fax:
Practice Address - Street 1:1300 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2031
Practice Address - Country:US
Practice Address - Phone:631-727-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program