MEDICARE: MRS. MALKA CARMAZI D D S

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	1223G0001X	General Practice Dentistry	039646	NY

General Provider Information

NPI Number	:	1558343608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALKA CARMAZI D D S

Provider Business Mailing Address
First Line	:	19 MARTIN CT
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1619
Country	:	US
Telephone Number	:	516-773-4585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE
Second Line	:	ST B4
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-763-4522
Fax Number	:	718-968-1182

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/08/2007

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