Provider Demographics
NPI:1114735941
Name:GURBUNOV, MALKA DVORA
Entity type:Individual
Prefix:
First Name:MALKA
Middle Name:DVORA
Last Name:GURBUNOV
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 1:290 W ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5451
Mailing Address - Country:US
Mailing Address - Phone:845-351-0300
Mailing Address - Fax:
Practice Address - Street 1:290 W ROUTE 59
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5451
Practice Address - Country:US
Practice Address - Phone:845-351-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool