Basic Information
| Provider Information | |||||||||
| NPI: | 1033172952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALONE | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 7B JOHNSON RD | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121103003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187827733 | ||||||||
| FaxNumber: | 5187820800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 119952 | NY | N | Other Service Providers | Specialist | 208000000X | 119952 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0006X | 119952 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 091221000076 | 01 | NY | FIDELIS | OTHER | 9042525 | 01 | NY | MVP HEALTHCARE | OTHER | 00387513 | 05 | NY | MEDICAID | 10001265 | 01 | NY | CDPHP | OTHER | 042ZC1 | 01 | NY | EMPIRE BLUECROSS | OTHER | 143256 | 01 | NY | GHI-HMO | OTHER | 5019456 | 01 | NY | AETNA | OTHER |