Provider Demographics
NPI:1841379559
Name:MALAKSHANOVA RICHARDS, MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:MALAKSHANOVA RICHARDS
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 1:694 THOMPSON HOLLOW RD # 123
Mailing Address - Street 2:
Mailing Address - City:NEW KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12459-0035
Mailing Address - Country:US
Mailing Address - Phone:212-362-2000
Mailing Address - Fax:212-362-4499
Practice Address - Street 1:80 CENTRAL PARK W
Practice Address - Street 2:SUITE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5204
Practice Address - Country:US
Practice Address - Phone:212-362-8200
Practice Address - Fax:212-362-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02366732Medicaid
NYH75277Medicare UPIN
NY57S251Medicare ID - Type Unspecified