Provider Demographics
NPI:1366101719
Name:MALIK, FATIMA MALIK
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:MALIK
Last Name:MALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 COLUMBUS AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5166
Mailing Address - Country:US
Mailing Address - Phone:212-595-4694
Mailing Address - Fax:
Practice Address - Street 1:471 COLUMBUS AVE APT 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5166
Practice Address - Country:US
Practice Address - Phone:212-595-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant