Provider Demographics
NPI:1912179011
Name:ALAN J MALITZ MD PC
Entity Type:Organization
Organization Name:ALAN J MALITZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-878-2223
Mailing Address - Street 1:284 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3226
Mailing Address - Country:US
Mailing Address - Phone:203-878-2223
Mailing Address - Fax:203-876-1915
Practice Address - Street 1:284 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3226
Practice Address - Country:US
Practice Address - Phone:203-878-2223
Practice Address - Fax:203-876-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00196013Medicaid
CT00196013Medicaid