Healthcare Provider Details

I. General information

NPI: 1760757165
Provider Name (Legal Business Name): MALO CENTER FOR AMBULATORY SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ROUTE 17 NORTH
RUTHERFORD NJ
07070-2574
US

IV. Provider business mailing address

201 ROUTE 17 FL 12
RUTHERFORD NJ
07070-2557
US

V. Phone/Fax

Practice location:
  • Phone: 201-549-8890
  • Fax:
Mailing address:
  • Phone: 201-372-1689
  • Fax: 866-203-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE PEREZ
Title or Position: BILLING MANAGER
Credential:
Phone: 201-372-1689