MEDICARE: MALIN FALU CASAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	20246	NY

General Provider Information

NPI Number	:	1326285750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIN FALU CASAC

Provider Business Mailing Address
First Line	:	3501 QUEENS BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1700
Country	:	US
Telephone Number	:	718-729-6868
Fax Number	:	718-729-8008

Provider Business Practice Location Address
First Line	:	3501 QUEENS BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1700
Country	:	US
Telephone Number	:	718-729-6868
Fax Number	:	718-729-8008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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