Provider Demographics
NPI:1194805713
Name:MALIK, SAFIULLAH M (MD FACS)
Entity type:Individual
Prefix:
First Name:SAFIULLAH
Middle Name:M
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2223 W STATE ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1938
Mailing Address - Country:US
Mailing Address - Phone:716-372-3474
Mailing Address - Fax:716-372-4370
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:SUITE 109
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1938
Practice Address - Country:US
Practice Address - Phone:716-372-3474
Practice Address - Fax:716-372-4370
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1584811208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000500459D01OtherCOMMUNITY BLUE
NY00891603Medicaid
NY10109701OtherUNIVERA
B71061Medicare UPIN
NY10109701OtherUNIVERA