Healthcare Provider Details

I. General information

NPI: 1730134263
Provider Name (Legal Business Name): VIRGINIA ANN MALKOSKIE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 STATE ROUTE 61
COAL TOWNSHIP PA
17866-4178
US

IV. Provider business mailing address

9300 STATE ROUTE 61
COAL TOWNSHIP PA
17866-4178
US

V. Phone/Fax

Practice location:
  • Phone: 570-648-8888
  • Fax: 570-648-8999
Mailing address:
  • Phone: 578-648-8888
  • Fax: 570-648-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE007917T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: