MEDICARE: ANTONIO MALICAT

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	163W00000X	Registered Nurse	550266-1	NY

General Provider Information

NPI Number	:	1841607033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO MALICAT

Provider Business Mailing Address
First Line	:	2286 BALMORAL AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2286 BALMORAL AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5204
Country	:	US
Telephone Number	:	908-416-0043
Fax Number	:

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

Provider Enumeration Date	:	07/19/2014
Last Update Date	:	07/19/2014

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Directions to “ ANTONIO MALICAT ” Practice Location

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