Healthcare Provider Details

I. General information

NPI: 1679332738
Provider Name (Legal Business Name): MICHELLE HOPE MALKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 22ND ST STE 530
LONG ISLAND CITY NY
11101-5029
US

IV. Provider business mailing address

4301 22ND ST STE 530
LONG ISLAND CITY NY
11101-5029
US

V. Phone/Fax

Practice location:
  • Phone: 929-777-0173
  • Fax:
Mailing address:
  • Phone: 929-777-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: