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General NPI Number Information
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NPI Number | 1538521703
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Entity Type | Organization
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Legal Business Name | LONG ISLAND DENTIST, PC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 15 OLD RIDGEFIELD RD
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City | WILTON
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State | CT
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Zip | 06897-3013
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Country | US
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Telephone | 203-762-9907
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Fax | 203-762-7002
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Provider Business Mailing Address
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Address Line | 2250 86TH ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11214-4139
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Country | US
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Telephone | 718-372-2800
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Fax | 718-372-1090
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Authorized Official
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Title or Position | PRESIDENT/ DENTIST
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Name | DR. MARIYA MALIN
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Credential | DDS
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Telephone | 203-762-9907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053295
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License Number State | NY
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