Provider Demographics
NPI:1427094473
Name:MALHOTRA, MANOJ (MD)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
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:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-0305
Mailing Address - Country:US
Mailing Address - Phone:216-403-3901
Mailing Address - Fax:201-553-0005
Practice Address - Street 1:13 LYDIA DR
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-8301
Practice Address - Country:US
Practice Address - Phone:216-403-3901
Practice Address - Fax:201-553-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350749592084N0400X
NY2505412084N0400X
NJ25MA084892002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2116678Medicaid
OH000000386727OtherANTHEM BC
OH000000386727OtherANTHEM BC
G89195Medicare UPIN