Provider Demographics
NPI:1275096869
Name:MALONES, RITA JAUOD
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:JAUOD
Last Name:MALONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2406
Mailing Address - Country:US
Mailing Address - Phone:973-224-3022
Mailing Address - Fax:973-383-0628
Practice Address - Street 1:20 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2406
Practice Address - Country:US
Practice Address - Phone:973-224-3022
Practice Address - Fax:973-383-0628
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00907700364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology