Basic Information
| Provider Information | |||||||||
| NPI: | 1831129337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALATESTA | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 MILLBURN AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MILLBURN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734677976 | ||||||||
| FaxNumber: | 9734677971 | ||||||||
| Practice Location | |||||||||
| Address1: | 187 MILLBURN AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MILLBURN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734677976 | ||||||||
| FaxNumber: | 9734677971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40AQ00650200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.