Provider Demographics
NPI:1902020373
Name:MALMBERG, GERTRUD CAROLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GERTRUD
Middle Name:CAROLINE
Last Name:MALMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:QUATTRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-0546
Mailing Address - Country:US
Mailing Address - Phone:201-945-6500
Mailing Address - Fax:201-945-1157
Practice Address - Street 1:663 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:201-945-6500
Practice Address - Fax:201-945-1157
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7065208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice