=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326318619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRY T. MALIN MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2012
-----------------------------------------------------
Last Update Date | 01/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6333 MAIN ST
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-634-6621
-----------------------------------------------------
Fax | 716-634-1584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6333 MAIN ST
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-634-6621
-----------------------------------------------------
Fax | 716-634-1584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/ OWNER
-----------------------------------------------------
Name | BARRY T MALIN
-----------------------------------------------------
Credential | MD, PC
-----------------------------------------------------
Telephone | 716-634-6621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 090118-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------