Healthcare Provider Details

I. General information

NPI: 1144426149
Provider Name (Legal Business Name): ROBERT W MALIZIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RICHMOND RD SUITE 1A
STATEN ISLAND NY
10304-2313
US

IV. Provider business mailing address

1551 RICHMOND RD SUITE 1A
STATEN ISLAND NY
10304-2313
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-4891
  • Fax: 718-987-4893
Mailing address:
  • Phone: 718-987-4891
  • Fax: 718-987-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number263906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: