Provider Demographics
NPI:1104587690
Name:MALYGINA, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:MALYGINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 RIVERSIDE STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4404
Mailing Address - Country:US
Mailing Address - Phone:917-291-5642
Mailing Address - Fax:
Practice Address - Street 1:1326 RIVERSIDE STATION BLVD
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-4404
Practice Address - Country:US
Practice Address - Phone:917-291-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348664-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily