Provider Demographics
NPI:1396706651
Name:MALEKI, KATANEH (MD)
Entity type:Individual
Prefix:DR
First Name:KATANEH
Middle Name:
Last Name:MALEKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOMERSET ST
Mailing Address - Street 2:1212
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-4800
Mailing Address - Country:US
Mailing Address - Phone:215-205-2824
Mailing Address - Fax:
Practice Address - Street 1:110 SOMERSET ST
Practice Address - Street 2:1212
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-4800
Practice Address - Country:US
Practice Address - Phone:215-205-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219278207RC0001X
NJ68232207RC0001X
PA419158207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02723233Medicaid
NJP00700493OtherRAILROAD MEDICARE PTAN
NJ0034941Medicaid
NJP00475133OtherRR MEDICARE PTAN
NJ102680DJGMedicare PIN
NYH63401Medicare UPIN
NJP00700493OtherRAILROAD MEDICARE PTAN
NJ102680DJGMedicare PIN