Healthcare Provider Details

I. General information

NPI: 1528217296
Provider Name (Legal Business Name): NADER KIM EL-MALLAWANY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SUNSHINE COTTAGE RD MUNGER PAVILION, ROOM 110
VALHALLA NY
10595-1524
US

IV. Provider business mailing address

249 E 118TH ST APT 7B
NEW YORK NY
10035-4286
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number241045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: