Provider Demographics
NPI:1114203163
Name:MALI, AMITA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:AMITA
Middle Name:
Last Name:MALI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 3RD ST
Mailing Address - Street 2:APT-3
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2803
Mailing Address - Country:US
Mailing Address - Phone:303-324-4763
Mailing Address - Fax:
Practice Address - Street 1:2147 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3365
Practice Address - Country:US
Practice Address - Phone:732-777-9733
Practice Address - Fax:732-777-9730
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01469900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist