Individual
JAY V MALICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
798 CENTERTON RD, ELMER, NJ 08318-3945
(856) 358-6161
(856) 358-0142
Mailing address
PO BOX 2284, VINELAND, NJ 08362-2284
(856) 358-6161
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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