Provider Demographics
NPI:1164035895
Name:WIDOFSKY, MALKA TZIPORAH (LAC)
Entity type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:TZIPORAH
Last Name:WIDOFSKY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11216 PRELUDE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5057
Mailing Address - Country:US
Mailing Address - Phone:908-875-3800
Mailing Address - Fax:
Practice Address - Street 1:10723 COLUMBIA PIKE STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4445
Practice Address - Country:US
Practice Address - Phone:301-754-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist