Provider Demographics
NPI:1649502253
Name:MALINOWSKI, LISA (LPN)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 KING RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9396
Mailing Address - Country:US
Mailing Address - Phone:631-512-5462
Mailing Address - Fax:631-821-3065
Practice Address - Street 1:33 KING RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9396
Practice Address - Country:US
Practice Address - Phone:631-512-5462
Practice Address - Fax:631-821-3065
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282937164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse