Healthcare Provider Details

I. General information

NPI: 1427558733
Provider Name (Legal Business Name): DEMETRA MALAMATENIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 ALBANY POST RD
CROTON ON HUDSON NY
10520-1562
US

IV. Provider business mailing address

86 SHELLEY AVE
YONKERS NY
10701-5440
US

V. Phone/Fax

Practice location:
  • Phone: 914-271-4726
  • Fax:
Mailing address:
  • Phone: 914-943-8568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number060705
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: