Provider Demographics
NPI:1063785905
Name:MALKIS, AVI (DDS)
Entity type:Individual
Prefix:DR
First Name:AVI
Middle Name:
Last Name:MALKIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 82ND ST
Mailing Address - Street 2:APARTMENT 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2742
Mailing Address - Country:US
Mailing Address - Phone:347-524-4222
Mailing Address - Fax:
Practice Address - Street 1:222 E 82ND ST
Practice Address - Street 2:APARTMENT 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2742
Practice Address - Country:US
Practice Address - Phone:347-524-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010670122300000X
PADS038942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist