Provider Demographics
NPI:1821437419
Name:DUBROFF, MALKA T (OTN/R)
Entity Type:Individual
Prefix:
First Name:MALKA
Middle Name:T
Last Name:DUBROFF
Suffix:
Gender:F
Credentials:OTN/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 LEFFERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1213
Mailing Address - Country:US
Mailing Address - Phone:718-902-7604
Mailing Address - Fax:
Practice Address - Street 1:738 LEFFERTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1213
Practice Address - Country:US
Practice Address - Phone:718-902-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01 8070-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist