Provider Demographics
NPI:1407027766
Name:GEORGE MALKE DDS PC
Entity Type:Organization
Organization Name:GEORGE MALKE DDS PC
Other - Org Name:GEORGE MALKE DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-845-9334
Mailing Address - Street 1:505 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4657
Mailing Address - Country:US
Mailing Address - Phone:201-845-9334
Mailing Address - Fax:201-845-9335
Practice Address - Street 1:505 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4657
Practice Address - Country:US
Practice Address - Phone:201-845-9334
Practice Address - Fax:201-845-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18805261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental