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Individual
JAY V MALICKEL
Active
Individual
JAY V MALICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB06869400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085366400
AMERIHEALTH
—
01
—
223772973
TAX ID
—
01
—
2325972
AETNA/HMO
—
01
—
60009045
NJ HEALTH
—
01
—
7591121
AETNA PIN
—
05
—
8223904
—
NJ
Enumeration date
10/03/2005
Last updated
09/10/2012
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