Healthcare Provider Details

I. General information

NPI: 1174760656
Provider Name (Legal Business Name): MALKA BAKER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GUSTAVE L LEVY PLACE BOX 1495
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE LEVY L PLACE BOX 4195
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 718-865-6816
  • Fax:
Mailing address:
  • Phone: 718-865-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335802
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number594585-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: