MEDICARE: MS. EDA M. MALENKY RN,MS,CS

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	282329	NY

General Provider Information

NPI Number	:	1538141312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EDA M. MALENKY RN,MS,CS

Provider Business Mailing Address
First Line	:	861 PACIFIC ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3119
Country	:	US
Telephone Number	:	718-783-4076
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 PACIFIC ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3119
Country	:	US
Telephone Number	:	718-783-4076
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/03/2010

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