Individual
DR. MARIO SUPAN MALONZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1012 E GUN HILL RD, BRONX, NY 10469-3720
(718) 918-8850
Mailing address
56 WALWORTH AVE, SCARSDALE, NY 10583-1423
(914) 725-0751
(914) 722-1730
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
152890
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00898540
—
NY
Enumeration date
06/14/2007
Last updated
07/08/2007
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