MEDICARE: DR. MARINA MALAKSHANOVA RICHARDS M.D.

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	232320	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	:	1841379559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARINA MALAKSHANOVA RICHARDS M.D.

Provider Business Mailing Address
First Line	:	694 THOMPSON HOLLOW RD # 123
Second Line	:
City	:	NEW KINGSTON
State	:	NY
Zip	:	12459-0035
Country	:	US
Telephone Number	:	212-362-2000
Fax Number	:	212-362-4499

Provider Business Practice Location Address
First Line	:	80 CENTRAL PARK W
Second Line	:	SUITE B
City	:	NEW YORK
State	:	NY
Zip	:	10023-5204
Country	:	US
Telephone Number	:	212-362-8200
Fax Number	:	212-362-4499

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	11/03/2020

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