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NPI Code Detail

MEDICARE: DR. CARMEN ROSA MALLAMACI M.D.

MEDICARE: DR. CARMEN ROSA MALLAMACI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMA62037NJ

General Provider Information

NPI Number : 1457314346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARMEN ROSA MALLAMACI M.D.
Provider Business Mailing Address
First Line : 18 STIRLING TER
Second Line :
City : TOTOWA
State : NJ
Zip : 07512-2185
Country : US
Telephone Number : 973-720-1677
Fax Number :
Provider Business Practice Location Address
First Line : 21 MARKET ST
Second Line :
City : PATERSON
State : NJ
Zip : 07501-1723
Country : US
Telephone Number : 973-754-4200
Fax Number : 973-754-4259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 11/05/2010

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