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General NPI Number Information
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NPI Number | 1356510622
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Entity Type | Individual
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Provider Name | MALA SACHDEVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 100 COMMUNITY DR 2ND FLOOR
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City | GREAT NECK
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State | NY
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Zip | 11021-5501
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Country | US
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Telephone | 646-643-8464
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Fax |
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Provider Business Mailing Address
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Address Line | 9554 111TH ST
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1023
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Country | US
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Telephone | 646-643-8464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 229744
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License Number State | NY
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