Provider Demographics
NPI:1932143161
Name:MALEY, MARYKAY (RN, APN C)
Entity Type:Individual
Prefix:MS
First Name:MARYKAY
Middle Name:
Last Name:MALEY
Suffix:
Gender:F
Credentials:RN, APN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3068
Practice Address - Country:US
Practice Address - Phone:856-235-0290
Practice Address - Fax:856-235-0601
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08106600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7399600Medicaid
003325SK3Medicare PIN
077356Medicare Oscar/Certification
NJMA003325Medicare ID - Type UnspecifiedMEDICARE NUMBER
NJ7399600Medicaid