Provider Demographics
NPI:1740388917
Name:MALINA, YELENA (MD)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:MALINA
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 1:2426 MERMAID AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2389
Mailing Address - Country:US
Mailing Address - Phone:718-676-2055
Mailing Address - Fax:718-676-2088
Practice Address - Street 1:2426 MERMAID AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2389
Practice Address - Country:US
Practice Address - Phone:718-676-2055
Practice Address - Fax:718-676-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02817027Medicaid
NY02817027Medicaid
NY721Z81Medicare ID - Type Unspecified