Provider Demographics
NPI:1639461072
Name:MARK E MALETSKY, M.D. P.A.
Entity Type:Organization
Organization Name:MARK E MALETSKY, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-492-1757
Mailing Address - Street 1:2025 HAMBURG TPKE
Mailing Address - Street 2:SUITE G
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6260
Mailing Address - Country:US
Mailing Address - Phone:973-492-1757
Mailing Address - Fax:973-492-6580
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:SUITE G
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-492-1757
Practice Address - Fax:973-492-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1342606Medicaid
C59476Medicare UPIN