Healthcare Provider Details

I. General information

NPI: 1255131256
Provider Name (Legal Business Name): TANJA MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 FRANKLIN STREET SUITE1
BLOOMFIELD NJ
07003
US

IV. Provider business mailing address

347 FRANKLIN STREET SUITE1
BLOOMFIELD NJ
07003
US

V. Phone/Fax

Practice location:
  • Phone: 973-951-6981
  • Fax:
Mailing address:
  • Phone: 973-951-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: