Provider Demographics
NPI:1881884088
Name:DEBRA MALLEY, MD LLC
Entity type:Organization
Organization Name:DEBRA MALLEY, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-309-0345
Mailing Address - Street 1:88 LAKEVIEW DR S
Mailing Address - Street 2:BLDG 2, SUITE A
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1229
Mailing Address - Country:US
Mailing Address - Phone:856-309-0345
Mailing Address - Fax:856-309-1213
Practice Address - Street 1:88 LAKEVIEW DR S
Practice Address - Street 2:BLDG 2, SUITE A
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1229
Practice Address - Country:US
Practice Address - Phone:856-309-0345
Practice Address - Fax:856-309-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG28015Medicare UPIN