# BHOOSA MALLIAH, MD. PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BHOOSAMALLIAH,MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639145436
- **Authorized official:** DR. BHOOSA MALLIAH M.D. (PHYSICIAN)
- **Authorized official phone:** (732) 840-8688

## Contact information

- **Practice address:** 222 JACK MARTIN BLVD, SUITE. E,, BRICKTOWN, NJ 08724-7772
- **Practice address phone:** (732) 840-8688
- **Practice address fax:** (732) 840-8480
- **Mailing address:** 222 JACK MARTIN BLVD, SUITE. E,, BRICKTOWN, NJ 08724-7772
- **Mailing address phone:** (732) 840-8688
- **Mailing address fax:** (732) 840-8480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0000X | Adolescent Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0000X | Adolescent Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2006
- **Last updated:** 09/20/2007