MEDICARE: MS. CLARICE MAALA N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	F340561	NY
2	363LA2200X	Adult Health Nurse Practitioner	303709	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205875200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLARICE MAALA N.P.

Provider Business Mailing Address
First Line	:	3411 WAYNE AVE
Second Line	:	MONTEFIORE MEDICAL CENTER/ DEPARTMENT OF HEMATOLOGY
City	:	BRONX
State	:	NY
Zip	:	10467-2509
Country	:	US
Telephone Number	:	718-920-6310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 WAYNE AVE
Second Line	:	MONTEFIORE MEDICAL CENTER/ DEPARTMENT OF HEMATOLOGY
City	:	BRONX
State	:	NY
Zip	:	10467-2509
Country	:	US
Telephone Number	:	718-920-6310
Fax Number	:	718-882-8698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	01/27/2009

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