Provider Demographics
NPI:1457409286
Name:HERMELE, MALCOLM H (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:H
Last Name:HERMELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE A-117
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-687-7250
Mailing Address - Fax:908-964-0188
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE A-117
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-687-7250
Practice Address - Fax:908-964-0188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02501400207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56131Medicare UPIN
NJ459643Medicare ID - Type Unspecified