Provider Demographics
NPI:1487240172
Name:MALIMPENET, SYDNEY ISRAEL (DNP, FNP-BC, CEN)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:ISRAEL
Last Name:MALIMPENET
Suffix:
Gender:M
Credentials:DNP, FNP-BC, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 46TH ST # 3R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1606
Mailing Address - Country:US
Mailing Address - Phone:347-465-2890
Mailing Address - Fax:
Practice Address - Street 1:3126 46TH ST # 3R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1606
Practice Address - Country:US
Practice Address - Phone:347-465-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346911-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily