Provider Demographics
NPI:1316211287
Name:MALAPO, REGINALD
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:
Last Name:MALAPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336B MATAWAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07721-1247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:336B MATAWAN AVE
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-1247
Practice Address - Country:US
Practice Address - Phone:732-514-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00490200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist