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Individual

ANABELLE MALONG SAN PEDRO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4195 FORLEY ST FL 3, ELMHURST, NY 11373-2656
(347) 264-3079
Mailing address
4195 FORLEY ST FL 3, ELMHURST, NY 11373-2656
(347) 264-3079

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
685112
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
908100967
NEW YORK STATE IDENTIFICATION CARD
NY
Enumeration date
09/04/2020
Last updated
09/04/2020
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