Healthcare Provider Details

I. General information

NPI: 1174547665
Provider Name (Legal Business Name): CATHLEEN DONOVAN MALOY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DRIVE SUITE G-3
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

1100 WESCOTT DRIVE SUITE G-3
FLEMINGTON NJ
08822
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6471
  • Fax: 908-788-6460
Mailing address:
  • Phone: 908-788-6471
  • Fax: 908-788-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00004100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: