=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326288168
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE MARY MALBON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2009
-----------------------------------------------------
Last Update Date | 03/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 E 94TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-731-7639
-----------------------------------------------------
Fax | 212-423-2994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 PIERREPONT ST 6D
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-276-3067
-----------------------------------------------------
Fax | 347-423-2994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | 003291
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------