Provider Demographics
NPI:1750478418
Name:MALETSKY, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MALETSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HAMBURG TURNPIKE
Mailing Address - Street 2:SUITE G
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-835-3224
Mailing Address - Fax:973-835-0779
Practice Address - Street 1:2025 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE G
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-835-3224
Practice Address - Fax:973-835-0779
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41272207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C59476Medicare UPIN
458544Medicare ID - Type Unspecified