Provider Demographics
NPI:1285092759
Name:MALOLES, RONALD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MALOLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 38TH ST RM 1305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9521
Mailing Address - Country:US
Mailing Address - Phone:212-943-1404
Mailing Address - Fax:646-355-0229
Practice Address - Street 1:307 W 38TH ST RM 1305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9521
Practice Address - Country:US
Practice Address - Phone:212-943-1404
Practice Address - Fax:646-355-0229
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010887225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant