Provider Demographics
NPI:1730284647
Name:IROKU-MALIZE, TOCHI (MD)
Entity Type:Individual
Prefix:
First Name:TOCHI
Middle Name:
Last Name:IROKU-MALIZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6924
Mailing Address - Country:US
Mailing Address - Phone:631-665-7240
Mailing Address - Fax:631-665-7242
Practice Address - Street 1:48 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6924
Practice Address - Country:US
Practice Address - Phone:631-665-7240
Practice Address - Fax:631-665-7242
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225534-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02315979Medicaid
NY02315979Medicaid
NY5094C1Medicare PIN