MEDICARE: MALESHOK INC

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	252Y00000X	Early Intervention Provider Agency		NY

General Provider Information

NPI Number	:	1437602695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALESHOK INC

Provider Business Mailing Address
First Line	:	425 NEPTUNE AVE APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224
Country	:	US
Telephone Number	:	718-266-4492
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 NEPTUNE AVE APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4542
Country	:	US
Telephone Number	:	718-266-4492
Fax Number	:

Authorized Official
Title or Position	:	TEACHER
Name	:	ANNA BEZUYEVSKAYA
Credential	:
Telephone Number	:	718-266-4492

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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Directions to “MALESHOK INC ” Practice Location

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