Healthcare Provider Details

I. General information

NPI: 1538141312
Provider Name (Legal Business Name): EDA M. MALENKY RN,MS,CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 PACIFIC ST
BROOKLYN NY
11238-3119
US

IV. Provider business mailing address

861 PACIFIC ST
BROOKLYN NY
11238-3119
US

V. Phone/Fax

Practice location:
  • Phone: 718-783-4076
  • Fax:
Mailing address:
  • Phone: 718-783-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number282329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: