Healthcare Provider Details

I. General information

NPI: 1861691602
Provider Name (Legal Business Name): REENA MALHOTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

4644 218TH ST
BAYSIDE NY
11361-3540
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7175
  • Fax:
Mailing address:
  • Phone: 718-631-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number245154
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number245154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: