Provider Demographics
NPI:1487318754
Name:MALEV, VICTORIA (RD, CDN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MALEV
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 2ND AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1307
Mailing Address - Country:US
Mailing Address - Phone:917-209-4126
Mailing Address - Fax:
Practice Address - Street 1:1492 2ND AVE APT 4A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1307
Practice Address - Country:US
Practice Address - Phone:917-209-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005675-01133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist