Provider Demographics
NPI:1689868192
Name:MALOUF, PATRICK M (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:MALOUF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508
Mailing Address - Country:US
Mailing Address - Phone:845-831-3059
Mailing Address - Fax:845-838-2885
Practice Address - Street 1:1181 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508
Practice Address - Country:US
Practice Address - Phone:845-831-3059
Practice Address - Fax:845-838-2885
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYX0091201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
9120OtherWC
X8X25OtherBCBS
9120OtherWC