Healthcare Provider Details

I. General information

NPI: 1124860275
Provider Name (Legal Business Name): MALIA MADISON HOAG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE STE 16N1-12
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-2359
  • Fax: 212-263-1048
Mailing address:
  • Phone: 212-562-2359
  • Fax: 212-263-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: