Provider Demographics
NPI:1023537164
Name:MLT MEDICAL LLC
Entity type:Organization
Organization Name:MLT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-787-1148
Mailing Address - Street 1:5 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4311
Mailing Address - Country:US
Mailing Address - Phone:201-787-1148
Mailing Address - Fax:
Practice Address - Street 1:137 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045
Practice Address - Country:US
Practice Address - Phone:201-787-1148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-09
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health