Healthcare Provider Details

I. General information

NPI: 1336079847
Provider Name (Legal Business Name): EUGENIE MALENFANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 GRAHAM AVE
BROOKLYN NY
11211-1415
US

IV. Provider business mailing address

72 BERRY ST APT 2D
BROOKLYN NY
11249-1938
US

V. Phone/Fax

Practice location:
  • Phone: 718-349-5912
  • Fax:
Mailing address:
  • Phone: 418-951-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: