Provider Demographics
NPI:1528220225
Name:MALIT, MICHELE FARRAH (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:FARRAH
Last Name:MALIT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:733 N BEERS ST STE U3
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1513
Mailing Address - Country:US
Mailing Address - Phone:732-847-3300
Mailing Address - Fax:732-739-5295
Practice Address - Street 1:733 N BEERS ST STE U3
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1513
Practice Address - Country:US
Practice Address - Phone:732-847-3300
Practice Address - Fax:732-739-5295
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18166208600000X, 208C00000X
NJ25MB09558200208600000X, 208C00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program