1336371202 NPI number — MRS. RACHAEL ERIN MALY M.S, CCC/SLP

Table of content: MRS. RACHAEL ERIN MALY M.S, CCC/SLP (NPI 1336371202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336371202 NPI number — MRS. RACHAEL ERIN MALY M.S, CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALY
Provider First Name:
RACHAEL
Provider Middle Name:
ERIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S, CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COHEN
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S, CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336371202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 RIDGEVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-913-0100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 MILL HILL AVE
Provider Second Line Business Practice Location Address:
BRIDGEPORT HOSPITAL
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-336-7346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  12106413 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)