Basic Information
| Provider Information | |||||||||
| NPI: | 1114203163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALI | ||||||||
| FirstName: | AMITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 247 3RD ST | ||||||||
| Address2: | APT-3 | ||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073022803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033244763 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2147 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088173365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327779733 | ||||||||
| FaxNumber: | 7327779730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2011 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01469900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.