1942300546 NPI number — ROSLYN KAREN MALMAUD PHD

Table of content: DR. MAITREYEE M GUPTA M.D. (NPI 1952505810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942300546 NPI number — ROSLYN KAREN MALMAUD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALMAUD
Provider First Name:
ROSLYN
Provider Middle Name:
KAREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942300546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3975 NW 27TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-271-6776
Provider Business Mailing Address Fax Number:
561-368-0459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 NE SPANISH RIVER BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-271-6776
Provider Business Practice Location Address Fax Number:
561-997-9971
Provider Enumeration Date:
09/23/2006

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: 103TC0700X , with the licence number:  4234 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 20069 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32003 . This is a "NATIONAL REGISTER 4 PSYCH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11403681 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11403681 . This is a "CAQH #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 240591220 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 180217 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 81962 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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