Provider Demographics
NPI:1104162767
Name:MALIK, KHURRAM SALEEM (MD)
Entity type:Individual
Prefix:DR
First Name:KHURRAM
Middle Name:SALEEM
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4149
Mailing Address - Country:US
Mailing Address - Phone:201-755-1923
Mailing Address - Fax:
Practice Address - Street 1:126 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307
Practice Address - Country:US
Practice Address - Phone:201-755-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09309800207RI0200X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease