Healthcare Provider Details

I. General information

NPI: 1720904295
Provider Name (Legal Business Name): SAMUEL MALEBRANCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FRANKLIN AVE STE 301
GARDEN CITY NY
11530-5942
US

IV. Provider business mailing address

7133A 260TH ST
GLEN OAKS NY
11004-1120
US

V. Phone/Fax

Practice location:
  • Phone: 516-740-1950
  • Fax:
Mailing address:
  • Phone: 718-974-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number131276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: