Provider Demographics
NPI:1750307195
Name:MALKIN, ALEXANDRA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:MALKIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E 44TH ST
Mailing Address - Street 2:302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4008
Mailing Address - Country:US
Mailing Address - Phone:212-490-3800
Mailing Address - Fax:212-490-6657
Practice Address - Street 1:144 E 44TH ST
Practice Address - Street 2:302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4008
Practice Address - Country:US
Practice Address - Phone:212-490-3800
Practice Address - Fax:212-490-6657
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QL2921Medicare PIN