Provider Demographics
NPI:1023054574
Name:MALMBERG, CORINNE ROCK (APN-C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:ROCK
Last Name:MALMBERG
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROUTE 37 W
Mailing Address - Street 2:RIVERWOOD II SUITE 303
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6400
Mailing Address - Country:US
Mailing Address - Phone:732-557-3530
Mailing Address - Fax:732-557-3540
Practice Address - Street 1:67 ROUTE 37 W
Practice Address - Street 2:RIVERWOOD II
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6400
Practice Address - Country:US
Practice Address - Phone:732-557-3530
Practice Address - Fax:732-557-3540
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN064583000363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8069000Medicaid
NJ031826NMWMedicare PIN
NJ031826PXFMedicare PIN
NJS90583Medicare UPIN