Healthcare Provider Details

I. General information

NPI: 1154007680
Provider Name (Legal Business Name): NARDEEN MALTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 36TH ST
UNION CITY NJ
07087-4712
US

IV. Provider business mailing address

402 36TH ST
UNION CITY NJ
07087-4712
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-3299
  • Fax:
Mailing address:
  • Phone: 201-866-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03103400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: