Provider Demographics
NPI:1033621842
Name:MALI, DIPTY (PT)
Entity Type:Individual
Prefix:
First Name:DIPTY
Middle Name:
Last Name:MALI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 KENNEDY BLVD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2057
Mailing Address - Country:US
Mailing Address - Phone:019-426-4242
Mailing Address - Fax:
Practice Address - Street 1:2520 KENNEDY BLVD # S1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2054
Practice Address - Country:US
Practice Address - Phone:019-426-4242
Practice Address - Fax:201-706-2376
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01583400OtherSTATE LICENSE