MEDICARE: MALIK TEKESINOVIC MARRIAGE AND FAMILY THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1679272314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALIK TEKESINOVIC MARRIAGE AND FAMILY THERAPY PLLC

Provider Business Mailing Address
First Line	:	2319 TIEMANN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6327
Country	:	US
Telephone Number	:	646-457-9842
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 TIEMANN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6327
Country	:	US
Telephone Number	:	646-457-9842
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MALIK TEKESINOVIC
Credential	:	LMFT
Telephone Number	:	646-457-9842

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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