Healthcare Provider Details

I. General information

NPI: 1104801984
Provider Name (Legal Business Name): VINCENT JOSEPH MALKOVITS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 MAHONING AVE FL 2
AUSTINTOWN OH
44515-2366
US

IV. Provider business mailing address

5533 MAHONING AVE FL 2
AUSTINTOWN OH
44515-2366
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-2701
  • Fax: 330-793-8688
Mailing address:
  • Phone: 330-793-2701
  • Fax: 330-793-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34006675
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34006675
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: