Provider Demographics
NPI:1285672915
Name:MALON, KATHLEEN (APN-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MALON
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07844-0268
Mailing Address - Country:US
Mailing Address - Phone:973-940-0116
Mailing Address - Fax:973-940-0104
Practice Address - Street 1:18 CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1756
Practice Address - Country:US
Practice Address - Phone:973-940-0116
Practice Address - Fax:973-940-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC4592400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7227701Medicaid
NJ904241Medicare PIN
NJS39195Medicare UPIN