Provider Demographics
NPI:1184037079
Name:KAHN, MALASA JOIS (DO)
Entity Type:Individual
Prefix:
First Name:MALASA
Middle Name:JOIS
Last Name:KAHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MALASA
Other - Middle Name:JOIS
Other - Last Name:KAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:100 VALLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2200
Mailing Address - Country:US
Mailing Address - Phone:973-965-8409
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2200
Practice Address - Country:US
Practice Address - Phone:973-965-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10218700207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN