Healthcare Provider Details

I. General information

NPI: 1306122874
Provider Name (Legal Business Name): LYNN MALANKA RN, RNFA, APN.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 US HIGHWAY 46 STE 400A
FAIRFIELD NJ
07004-1568
US

IV. Provider business mailing address

734 6TH ST
SECAUCUS NJ
07094-3012
US

V. Phone/Fax

Practice location:
  • Phone: 973-826-8291
  • Fax: 888-972-6480
Mailing address:
  • Phone: 201-600-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA0805236
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO11473000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: