Provider Demographics
NPI:1427003250
Name:MALALUAN, MARTIN SAMILLANO III (RPT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:SAMILLANO
Last Name:MALALUAN
Suffix:III
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:730 PALISADE AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3144
Mailing Address - Country:US
Mailing Address - Phone:201-692-9699
Mailing Address - Fax:201-692-9699
Practice Address - Street 1:205 ROBIN RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1449
Practice Address - Country:US
Practice Address - Phone:201-225-1511
Practice Address - Fax:201-225-9731
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA01144000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist