Provider Demographics
NPI:1487684841
Name:MALAVADE, EKANATH D (MD)
Entity Type:Individual
Prefix:
First Name:EKANATH
Middle Name:D
Last Name:MALAVADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:681 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3318
Mailing Address - Country:US
Mailing Address - Phone:201-836-2262
Mailing Address - Fax:201-287-0964
Practice Address - Street 1:681 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3318
Practice Address - Country:US
Practice Address - Phone:201-836-2262
Practice Address - Fax:201-287-0964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB17920Medicare UPIN