Basic Information
Provider Information
NPI: 1487724662
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALINA
FirstName: CHERYL
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 GRAND ST
Address2: FL 3
City: WARWICK
State: NY
PostalCode: 109901035
CountryCode: US
TelephoneNumber: 8453685000
FaxNumber: 8459875979
Practice Location
Address1: MMC - DEPT OF EMERGENCY MED
Address2: 1825 EASTCHESTER ROAD
City: BRONX
State: NY
PostalCode: 10467
CountryCode: US
TelephoneNumber: 7189043333
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/08/2006
LastUpdateDate: 12/05/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X237979NYY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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