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NPI Code Detail

MEDICARE: DEBRA MALLEY, MD LLC

MEDICARE: DEBRA MALLEY, MD LLC
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
1174400000XSpecialistMA63875NJ

General Provider Information

NPI Number : 1881884088
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEBRA MALLEY, MD LLC
Provider Business Mailing Address
First Line : 88 LAKEVIEW DR S
Second Line : BLDG 2, SUITE A
City : GIBBSBORO
State : NJ
Zip : 08026-1229
Country : US
Telephone Number : 856-309-0345
Fax Number : 856-309-1213
Provider Business Practice Location Address
First Line : 88 LAKEVIEW DR S
Second Line : BLDG 2, SUITE A
City : GIBBSBORO
State : NJ
Zip : 08026-1229
Country : US
Telephone Number : 856-309-0345
Fax Number : 856-309-1213
Authorized Official
Title or Position : OWNER
Name : DR. DEBRA S MALLEY
Credential : M.D.
Telephone Number : 856-309-0345
Provider Enumeration Date : 07/25/2007
Last Update Date : 07/25/2007

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