Provider Demographics
NPI:1932300340
Name:MALAKOV, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MALAKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-120 QUEENS BLVD
Mailing Address - Street 2:SUITE 1LM
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-897-3434
Mailing Address - Fax:718-997-0342
Practice Address - Street 1:98-120 QUEENS BLVD
Practice Address - Street 2:SUITE 1LM
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-897-3434
Practice Address - Fax:718-997-0342
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01893021Medicaid
03123Medicare ID - Type Unspecified
NY01893021Medicaid