Healthcare Provider Details

I. General information

NPI: 1740388917
Provider Name (Legal Business Name): YELENA MALINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 MERMAID AVE STE 1
BROOKLYN NY
11224-2389
US

IV. Provider business mailing address

2426 MERMAID AVE STE 1
BROOKLYN NY
11224-2389
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-2055
  • Fax: 718-676-2088
Mailing address:
  • Phone: 718-676-2055
  • Fax: 718-676-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: