Individual
DR. MALKHAZI MIKADZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 PROSPECT AVE, PEDIATRICS DEPT, HACKENSACK, NJ 07601-1914
(201) 996-2000
Mailing address
224 E NORTHFIELD RD, LIVINGSTON, NJ 07039-4801
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MA07954800
NJ
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
25MA07954800
NJ
Other
Enumeration date
06/09/2006
Last updated
01/02/2025
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