Healthcare Provider Details

I. General information

NPI: 1265410831
Provider Name (Legal Business Name): DIPAKKUMAR PURUSHOTTAM MALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E EVESHAM RD
CHERRY HILL NJ
08003-3949
US

IV. Provider business mailing address

1416 SPRUCE AVE
VOORHEES NJ
08043-3649
US

V. Phone/Fax

Practice location:
  • Phone: 856-427-4477
  • Fax: 856-427-9199
Mailing address:
  • Phone: 609-471-1000
  • Fax: 856-427-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA07352400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA07352400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA07352400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: