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General NPI Number Information
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NPI Number | 1255428124
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Entity Type | Individual
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Provider Name | NERISSA MALABANAN MD
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 1222 KENNEDY BLVD
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City | BAYONNE
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State | NJ
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Zip | 07002-9211
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Country | US
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Telephone | 201-319-9800
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Fax | 201-437-9661
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Provider Business Mailing Address
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Address Line | 3196 KENNEDY BLVD SUITE 2
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City | UNION CITY
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State | NJ
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Zip | 07087-2436
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Country | US
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Telephone | 201-319-9800
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Fax | 201-437-9661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA06095100
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License Number State | NJ
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