Provider Demographics
NPI:1023391737
Name:MALKIN, SPENCER JASON (DC)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:JASON
Last Name:MALKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E PARK AVE
Mailing Address - Street 2:SUITE 633
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3521
Mailing Address - Country:US
Mailing Address - Phone:917-815-2299
Mailing Address - Fax:516-706-1085
Practice Address - Street 1:415 AVENUE P
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1824
Practice Address - Country:US
Practice Address - Phone:917-815-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008635-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor