Provider Demographics
NPI:1841943149
Name:AMALIA K INC
Entity type:Organization
Organization Name:AMALIA K INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKALENIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-468-4048
Mailing Address - Street 1:14415 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1326
Mailing Address - Country:US
Mailing Address - Phone:917-468-4048
Mailing Address - Fax:
Practice Address - Street 1:14415 26TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1326
Practice Address - Country:US
Practice Address - Phone:917-468-4048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016178OtherLICENSE