Provider Demographics
NPI:1215125638
Name:GARFINKLE, MALCOLM JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:JAY
Last Name:GARFINKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27225 CALAROGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4338
Mailing Address - Country:US
Mailing Address - Phone:510-780-9148
Mailing Address - Fax:510-780-9149
Practice Address - Street 1:27225 CALAROGA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4338
Practice Address - Country:US
Practice Address - Phone:510-780-9148
Practice Address - Fax:510-780-9149
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22474208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G224740Medicaid
CAC04138Medicare UPIN
CA00G224740Medicare PIN