Provider Demographics
NPI:1659373785
Name:MALTA, WILLIAM J (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:MALTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1917
Mailing Address - Country:US
Mailing Address - Phone:973-379-7022
Mailing Address - Fax:973-379-7023
Practice Address - Street 1:127 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1917
Practice Address - Country:US
Practice Address - Phone:973-379-7022
Practice Address - Fax:973-379-7023
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00325100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP484089OtherOXFORD
NJ536543Medicare ID - Type Unspecified
NJ6600730001Medicare NSC