Provider Demographics
NPI:1851399588
Name:MALAZARTE, JUSTITO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTITO
Middle Name:
Last Name:MALAZARTE
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:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-0758
Mailing Address - Country:US
Mailing Address - Phone:973-779-7361
Mailing Address - Fax:973-779-7385
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:973-779-7361
Practice Address - Fax:973-779-7385
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63536174400000X
NJ25MA06356300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7546408Medicaid
NJG34287Medicare UPIN
NJ7546408Medicaid