Individual
RANENDRA PRATAP MALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3422 57TH ST FL 1, WOODSIDE, NY 11377-2124
(347) 965-6607
Mailing address
3422 57TH ST FL 1, WOODSIDE, NY 11377-2124
(347) 965-6607
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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