Provider Demographics
NPI:1780964056
Name:MALATESTA, HEATHER M
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:MALATESTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SWEDESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1823
Mailing Address - Country:US
Mailing Address - Phone:856-275-8751
Mailing Address - Fax:856-478-0212
Practice Address - Street 1:309 SWEDESBORO RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1823
Practice Address - Country:US
Practice Address - Phone:856-275-8751
Practice Address - Fax:856-478-0212
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2015-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00062900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist