Healthcare Provider Details

I. General information

NPI: 1407434665
Provider Name (Legal Business Name): ADAM MALIK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E GUASTI RD STE 100
ONTARIO CA
91761-8661
US

IV. Provider business mailing address

6 HIGH MEADOW RD
GOSHEN NY
10924-5330
US

V. Phone/Fax

Practice location:
  • Phone: 909-789-0260
  • Fax: 909-789-0224
Mailing address:
  • Phone: 845-238-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A24824
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS023096
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: