Provider Demographics
NPI:1861924532
Name:MALO CLINICAL CENTER FOR AMBULATORY SURGERY, LLC
Entity type:Organization
Organization Name:MALO CLINICAL CENTER FOR AMBULATORY SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:516-622-6000
Mailing Address - Street 1:1 DAKOTA DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1135
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:516-622-2914
Practice Address - Street 1:201 ROUTE 17
Practice Address - Street 2:12TH FLOOR
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2574
Practice Address - Country:US
Practice Address - Phone:201-372-1689
Practice Address - Fax:516-622-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical