Healthcare Provider Details

I. General information

NPI: 1336302967
Provider Name (Legal Business Name): MALEK MNEIMNE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MENAHAN ST APT 3A
BROOKLYN NY
11237-5364
US

IV. Provider business mailing address

370 MENAHAN ST APT 3A
BROOKLYN NY
11237-5364
US

V. Phone/Fax

Practice location:
  • Phone: 516-225-1415
  • Fax:
Mailing address:
  • Phone: 516-225-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023113
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: