=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437745460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERA MALEZHIK DPM PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2020
-----------------------------------------------------
Last Update Date | 12/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 BROADWAY STE 931
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-261-4291
-----------------------------------------------------
Fax | 917-594-4881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 BROADWAY STE 931
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-261-4291
-----------------------------------------------------
Fax | 917-594-4881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST /PRESIDENT
-----------------------------------------------------
Name | DR. VERA MALEZHIK
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 917-261-4291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------