MEDICARE: MADHU MALHOTRA MD

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	207R00000X	Internal Medicine Physician	167949	NY

General Provider Information

NPI Number	:	1609986520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHU MALHOTRA MD

Provider Business Mailing Address
First Line	:	5801 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3819
Country	:	US
Telephone Number	:	718-439-9620
Fax Number	:	718-567-0406

Provider Business Practice Location Address
First Line	:	5801 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3819
Country	:	US
Telephone Number	:	718-439-9620
Fax Number	:	718-567-0406

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/17/2014

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