Provider Demographics
NPI:1386368918
Name:MALU, EDMUND
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:MALU
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 1:13559 231ST ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2533
Mailing Address - Country:US
Mailing Address - Phone:347-592-4203
Mailing Address - Fax:
Practice Address - Street 1:13559 231ST ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2533
Practice Address - Country:US
Practice Address - Phone:347-592-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst