Provider Demographics
NPI:1063562619
Name:NABIL N. ABDELMALAK & MARY S. TAWFIK, PHYSICIANS, P.C.
Entity type:Organization
Organization Name:NABIL N. ABDELMALAK & MARY S. TAWFIK, PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ABDELMALAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-982-8074
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-0270
Mailing Address - Country:US
Mailing Address - Phone:631-264-2035
Mailing Address - Fax:631-264-1418
Practice Address - Street 1:1725 E 12TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1028
Practice Address - Country:US
Practice Address - Phone:718-265-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NABIL N. ABDELMALAK & MARY S. TAWFIK, PHYSICIANS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-12
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02842377Medicaid
NY02842377Medicaid