Provider Demographics
NPI:1851467245
Name:KOENIG, MALKA (OTR CHT)
Entity Type:Individual
Prefix:MS
First Name:MALKA
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 AYCRIGG AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4775
Mailing Address - Country:US
Mailing Address - Phone:973-685-9177
Mailing Address - Fax:973-246-9176
Practice Address - Street 1:238 AYCRIGG AVE
Practice Address - Street 2:UNIT A
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4775
Practice Address - Country:US
Practice Address - Phone:973-685-9177
Practice Address - Fax:973-246-9176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006396225X00000X
NJ46TR00455400225X00000X
NJ9911000100225XH1200X
NY9911000100225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
03500600OtherCIGNA
1370057OtherUHC
1699825OtherGHI
NY02284715Medicaid
P2665470OtherOXFORD
7185402OtherAETNA
811127OtherMPN
P11211193OtherMULTIPLAN
QS5832OtherBCBS
811127OtherMPN
NYQS5831Medicare PIN