Provider Demographics
NPI:1548599822
Name:MALITZKY, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MALITZKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MAIN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5452
Mailing Address - Country:US
Mailing Address - Phone:973-591-1600
Mailing Address - Fax:973-591-1605
Practice Address - Street 1:145 MAIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5452
Practice Address - Country:US
Practice Address - Phone:973-591-1600
Practice Address - Fax:973-591-1605
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09131700208000000X
NY259436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics