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General NPI Number Information
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NPI Number | 1457688343
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Entity Type | Organization
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Legal Business Name | FREDERIC MALLEN, M.D., P.C.
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 3100 PRINCETON PIKE
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2300
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Country | US
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Telephone | 609-896-0101
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Fax | 609-896-1492
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Provider Business Mailing Address
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Address Line | 3100 PRINCETON PIKE
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2300
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Country | US
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Telephone | 609-896-0101
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Fax | 609-896-1492
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERIC J. MALLEN
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Credential |
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Telephone | 609-896-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MA35918
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License Number State | NJ
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