Provider Demographics
NPI:1215923685
Name:MALIK, ABDUL QAYYUM (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:QAYYUM
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 1:1 VILLADOM CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5444
Mailing Address - Country:US
Mailing Address - Phone:718-469-4006
Mailing Address - Fax:718-282-5577
Practice Address - Street 1:608 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1821
Practice Address - Country:US
Practice Address - Phone:718-469-4006
Practice Address - Fax:718-467-4004
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187398207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01298104Medicaid
F02356Medicare UPIN
10G061Medicare ID - Type Unspecified