Healthcare Provider Details

I. General information

NPI: 1164253787
Provider Name (Legal Business Name): MATTHEW S MALIN BSN, RN, EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8794 BOYNTON BEACH BLVD STE 216
BOYNTON BEACH FL
33472-4469
US

IV. Provider business mailing address

8794 BOYNTON BEACH BLVD STE 216
BOYNTON BEACH FL
33472-4469
US

V. Phone/Fax

Practice location:
  • Phone: 954-756-5262
  • Fax:
Mailing address:
  • Phone: 954-756-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9562578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: