Basic Information
| Provider Information | |||||||||
| NPI: | 1861924532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MALO CLINICAL CENTER FOR AMBULATORY SURGERY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DAKOTA DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226000 | ||||||||
| FaxNumber: | 5166222914 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 ROUTE 17 | ||||||||
| Address2: | 12TH FLOOR | ||||||||
| City: | RUTHERFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070702574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013721689 | ||||||||
| FaxNumber: | 5166222914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2017 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | PELLMAN | ||||||||
| AuthorizedOfficialFirstName: | ELLIOT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5166226000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.