Healthcare Provider Details

I. General information

NPI: 1841179702
Provider Name (Legal Business Name): RAYMOND MALAYEV NP IN ADULT HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7632 168TH ST
FRESH MEADOWS NY
11366-1334
US

IV. Provider business mailing address

7632 168TH ST
FRESH MEADOWS NY
11366-1334
US

V. Phone/Fax

Practice location:
  • Phone: 917-705-1140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND MALAYEV
Title or Position: OWNER
Credential: APRN
Phone: 917-705-1140