Provider Demographics
NPI:1457581118
Name:MALINOSKI, KRISTA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MALINOSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 CHURCH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8642
Mailing Address - Country:US
Mailing Address - Phone:518-264-0880
Mailing Address - Fax:518-264-0881
Practice Address - Street 1:377 CHURCH ST STE 2
Practice Address - Street 2:
Practice Address - City:SARATOGA SPGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8642
Practice Address - Country:US
Practice Address - Phone:518-264-0880
Practice Address - Fax:518-264-0881
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03138387Medicaid
NYJ400005020Medicare PIN