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General NPI Number Information
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NPI Number | 1740833193
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Entity Type | Individual
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Provider Name | SOPHIE MALAMUT
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 419 PARK AVE S RM 1305
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City | NEW YORK
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State | NY
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Zip | 10016-8433
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Country | US
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Telephone | 212-545-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 471 LAFAYETTE AVE APT 2
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City | BROOKLYN
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State | NY
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Zip | 11205-4872
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Country | US
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Telephone | 917-885-0920
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 421394
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License Number State | NY
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