Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 111N000000X | NJ |
Y | 213ER0200X | Radiology | 111N000000X | NJ |
NPI | 1902032261 |
---|---|
Provider Name | Ms. Margaret Malave II |
First Address | Irvington, NJ 07111-3067 |
Second Address | Irvington, NJ 07111-3067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2009 |
Last Update Date | 01/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CCN7770001128279402 | (05) | NJ |