ANATOLY MALOLETKIN – Psychiatric/Mental Health Nurse Practitioner, NPI 1215724539

ANATOLY MALOLETKIN is a healthcare provider. based in Fort lee, New Jersey. specializing in NURSE PRACTITIONER. They hold a License No. 26NJ15306000 (NJ). The NPI Number for ANATOLY MALOLETKIN is 1215724539

Main info

Male
2 Years Of Experience
Accepts Medicare Assignment
Name
ANATOLY MALOLETKIN
NPI
1215724539
Phone
(888) 701-6472
Address
2185 LEMOINE AVE STE 1H
Enumeration Date
21 April 2025
Last Update Date
21 April 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8887016472
Graduation Year
2024 (2 years ago)
PAC ID
5799202321
Group Practice PAC ID
8628462397
Professional Enrollment ID
I20250507002537
Address ID
NJ070246030FO2185XAVEX303
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

7,574 NURSE PRACTITIONER in NJ

Provider Addresses for ANATOLY MALOLETKIN

  • 2185 LEMOINE AVE STE 1H

    FORT LEE, NJ 070246030

    Phone: (888) 701-6472

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-05-07

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250507002537INurse PractitionerNJTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 07024)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8628462397View full group profile
NameSpecialtyState
P S Y C H I A T R YNJ

Reviews

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Frequently asked questions

What federal number belongs to ANATOLY MALOLETKIN?
The federal identifier for ANATOLY MALOLETKIN is NPI 1215724539.
Is ANATOLY MALOLETKIN's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What field does ANATOLY MALOLETKIN work in?
You can think of ANATOLY MALOLETKIN as practicing within Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location shows for ANATOLY MALOLETKIN?
We surface Fort Lee, New Jersey for ANATOLY MALOLETKIN based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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