Healthcare Provider Details

I. General information

NPI: 1295757177
Provider Name (Legal Business Name): SUANNE GARBER MALLENBAUM MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST AVE SUITE 215
LARCHMONT NY
10538-2470
US

IV. Provider business mailing address

PO BOX 318H
SCARSDALE NY
10583-8818
US

V. Phone/Fax

Practice location:
  • Phone: 914-834-4379
  • Fax: 914-381-2633
Mailing address:
  • Phone: 914-382-6308
  • Fax: 914-381-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number183699
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number183699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: