Provider Demographics
NPI:1164758421
Name:MALO CLINIC ADVANCED REHABILITATION,LLC
Entity Type:Organization
Organization Name:MALO CLINIC ADVANCED REHABILITATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-528-2297
Mailing Address - Street 1:201 ROUTE 17
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2574
Mailing Address - Country:US
Mailing Address - Phone:201-528-2297
Mailing Address - Fax:
Practice Address - Street 1:201 ROUTE 17
Practice Address - Street 2:11TH FLOOR
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2574
Practice Address - Country:US
Practice Address - Phone:201-528-2297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty