Provider Demographics
NPI:1295077717
Name:MALKIE JACOB
Entity type:Organization
Organization Name:MALKIE JACOB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS EDSPED
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-903-9886
Mailing Address - Street 1:577 GRAND ST APT 302
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-3587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:577 GRAND ST APT 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3587
Practice Address - Country:US
Practice Address - Phone:917-903-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY862680252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY445084224OtherDRIVER'S LICENSE