Provider Demographics
NPI:1093909822
Name:MALETTA, LON (PHD)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:
Last Name:MALETTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 LAWRENCEVILLE PENNING RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1651
Mailing Address - Country:US
Mailing Address - Phone:609-737-3356
Mailing Address - Fax:
Practice Address - Street 1:66 LAWRENCEVILLE PENNING RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1651
Practice Address - Country:US
Practice Address - Phone:609-737-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100102000103TC0700X
NY35S100102000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ550958Medicare PIN