Organization
MGM KETAMINE SERVICES LLC
Active
Other names
MGM Ketamine Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL MALINA MD (PHYSICIAN)
(201) 483-3760
Entity
Organization
Contact information
Practice address
690 KINDERKAMACK RD STE 103, ORADELL, NJ 07649-1524
(201) 483-3760
Mailing address
59 GLENORCHY PL, NEW ROCHELLE, NY 10804-3512
(201) 483-3760
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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