Healthcare Provider Details

I. General information

NPI: 1790762987
Provider Name (Legal Business Name): MALA VAZIRANI RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone: 718-470-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: