Provider Demographics
NPI:1861985301
Name:REILLY, JANINE MALLARI (DO)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:MALLARI
Last Name:REILLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HOAGLAND RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9754
Mailing Address - Country:US
Mailing Address - Phone:732-861-8158
Mailing Address - Fax:
Practice Address - Street 1:852 ROUTE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2343
Practice Address - Country:US
Practice Address - Phone:973-450-1991
Practice Address - Fax:973-528-8009
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB11037800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program