MEDICARE: DR. CARMELITA PINGOL MALALIS 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
1	2080A0000X	Pediatric Adolescent Medicine Physician	25MA03062500	NJ

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

General Provider Information

NPI Number	:	1598868523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMELITA PINGOL MALALIS M.D.

Provider Business Mailing Address
First Line	:	54 BARBOUR PLACE
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-3591
Country	:	US
Telephone Number	:	732-563-4424
Fax Number	:

Provider Business Practice Location Address
First Line	:	765 KENNEDY BLVD.
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-2804
Country	:	US
Telephone Number	:	201-437-9471
Fax Number	:	201-437-1590

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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