Healthcare Provider Details

I. General information

NPI: 1861985301
Provider Name (Legal Business Name): JANINE MALLARI REILLY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 03/06/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 ROUTE 3
CLIFTON NJ
07012-2343
US

IV. Provider business mailing address

23 HOAGLAND RD
BLAIRSTOWN NJ
07825-9754
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-1991
  • Fax: 973-528-8009
Mailing address:
  • Phone: 732-861-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB11037800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: