Provider Demographics
NPI:1659778892
Name:MALIZE, NICKOLAS (DPT)
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:MALIZE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WATERS PL STE 501
Mailing Address - Street 2:WSPT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2732
Mailing Address - Country:US
Mailing Address - Phone:718-409-9444
Mailing Address - Fax:718-409-0236
Practice Address - Street 1:1250 WATERS PL STE 501
Practice Address - Street 2:WSPT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2732
Practice Address - Country:US
Practice Address - Phone:718-409-9444
Practice Address - Fax:718-409-0236
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038440-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist