Provider Demographics
NPI:1043596083
Name:MALONZO, ROMEO JR
Entity Type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:
Last Name:MALONZO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4312
Mailing Address - Country:US
Mailing Address - Phone:201-384-4447
Mailing Address - Fax:201-384-1639
Practice Address - Street 1:406 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4312
Practice Address - Country:US
Practice Address - Phone:201-384-4447
Practice Address - Fax:201-384-1639
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02938600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist