Provider Demographics
NPI:1619843570
Name:MALAK, KEROLOS
Entity type:Individual
Prefix:
First Name:KEROLOS
Middle Name:
Last Name:MALAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEROLOS
Other - Middle Name:NADI
Other - Last Name:MALAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:255 ELVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:758 ARTHUR KILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2121
Practice Address - Country:US
Practice Address - Phone:718-317-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist