Healthcare Provider Details

I. General information

NPI: 1316211287
Provider Name (Legal Business Name): MR. REGINALD MALAPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336B MATAWAN AVE
CLIFFWOOD NJ
07721-1247
US

IV. Provider business mailing address

336B MATAWAN AVE
CLIFFWOOD NJ
07721-1247
US

V. Phone/Fax

Practice location:
  • Phone: 732-514-7806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00490200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: