Individual
LARISA MALISOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
420 LYNDALE AVE, STATEN ISLAND, NY 10312-6131
(718) 967-5630
Mailing address
1270 E 19TH ST, APT. 6 M, BROOKLYN, NY 11230-5457
(718) 338-0164
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
234484
NY
Other
Enumeration date
05/25/2006
Last updated
05/28/2010
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