Provider Demographics
NPI:1952696791
Name:GEORGE MALEGIANNAKIS PHYSICIAN PC
Entity Type:Organization
Organization Name:GEORGE MALEGIANNAKIS PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MALEGIANNAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-7595
Mailing Address - Street 1:1811 AVENUE P
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-375-7595
Mailing Address - Fax:718-375-7559
Practice Address - Street 1:1811 AVENUE P
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-375-7595
Practice Address - Fax:718-375-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499338Medicaid
NY1376503383OtherNPI
NYH77254Medicare UPIN
NY099AC1Medicare PIN