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General NPI Number Information
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NPI Number | 1023537164
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Entity Type | Organization
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Legal Business Name | MLT MEDICAL LLC
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 09/09/2017
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Provider Practice Location Address
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Address Line | 137 MAIN ROAD
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City | MONTVILLE
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State | NJ
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Zip | 07045
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Country | US
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Telephone | 201-787-1148
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Fax |
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Provider Business Mailing Address
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Address Line | 5 MITCHELL RD
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City | PARSIPPANY
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State | NJ
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Zip | 07054-4311
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Country | US
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Telephone | 201-787-1148
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. MICHELLE LYNN THORPE
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Credential | MD
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Telephone | 201-787-1148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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