Provider Demographics
NPI:1801191127
Name:VINCENT J MALKOVITS DO LLC
Entity Type:Organization
Organization Name:VINCENT J MALKOVITS DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALKOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-792-2976
Mailing Address - Street 1:25 N CANFIELD NILES RD
Mailing Address - Street 2:SUITE #160
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2328
Mailing Address - Country:US
Mailing Address - Phone:330-792-2976
Mailing Address - Fax:330-792-8707
Practice Address - Street 1:25 N CANFIELD NILES RD
Practice Address - Street 2:SUITE #160
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2328
Practice Address - Country:US
Practice Address - Phone:330-792-2976
Practice Address - Fax:330-792-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006675204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty