Provider Demographics
NPI:1457314346
Name:MALLAMACI, CARMEN ROSA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ROSA
Last Name:MALLAMACI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STIRLING TER
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2185
Mailing Address - Country:US
Mailing Address - Phone:973-720-1677
Mailing Address - Fax:
Practice Address - Street 1:21 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1723
Practice Address - Country:US
Practice Address - Phone:973-754-4200
Practice Address - Fax:973-754-4259
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8260109Medicare ID - Type Unspecified