MEDICARE: DR. MICHAEL K MALEY MD

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
1	207W00000X	Ophthalmology Physician	MD11898	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598742736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL K MALEY MD

Provider Business Mailing Address
First Line	:	619 RIVER DR
Second Line	:	SECOND FLOOR
City	:	ELMWOOD PARK
State	:	NJ
Zip	:	07407-1317
Country	:	US
Telephone Number	:	201-769-2020
Fax Number	:	201-796-3644

Provider Business Practice Location Address
First Line	:	619 RIVER DR
Second Line	:	SECOND FLOOR
City	:	ELMWOOD PARK
State	:	NJ
Zip	:	07407-1317
Country	:	US
Telephone Number	:	201-769-2020
Fax Number	:	201-796-3644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	02/14/2012

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