Provider Demographics
NPI:1649533696
Name:PILLA, MALATHI (MD)
Entity type:Individual
Prefix:
First Name:MALATHI
Middle Name:
Last Name:PILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALATHI
Other - Middle Name:
Other - Last Name:BONDADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1041 RTE 36 STE 206
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1041 RTE 36 STE 206
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2535
Practice Address - Country:US
Practice Address - Phone:732-982-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0620472084P0800X
NMMD2016-00832084P0800X
NJ25MA112861002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry