Provider Demographics
NPI:1972036804
Name:MALONEY, BRANDT
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:
Last Name:MALONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7034
Mailing Address - Country:US
Mailing Address - Phone:646-416-1233
Mailing Address - Fax:
Practice Address - Street 1:484 N EASTON BELMONT PIKE
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:646-416-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine