Healthcare Provider Details

I. General information

NPI: 1861420911
Provider Name (Legal Business Name): JOHN H MALFETANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COMPUTER DR W STE 100
ALBANY NY
12205-1612
US

IV. Provider business mailing address

24 COMPUTER DR W STE 100
ALBANY NY
12205-1612
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-7548
  • Fax: 518-489-7548
Mailing address:
  • Phone: 518-689-7548
  • Fax: 518-489-7548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number154115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: