Provider Demographics
NPI:1932485679
Name:MALILE, NEVILA (OROFACIAL MYOLOGIST)
Entity Type:Individual
Prefix:
First Name:NEVILA
Middle Name:
Last Name:MALILE
Suffix:
Gender:F
Credentials:OROFACIAL MYOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4001
Mailing Address - Country:US
Mailing Address - Phone:862-354-4466
Mailing Address - Fax:
Practice Address - Street 1:5 DOUGLAS CT
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-4001
Practice Address - Country:US
Practice Address - Phone:862-354-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ198-C-14174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist