Healthcare Provider Details

I. General information

NPI: 1205051604
Provider Name (Legal Business Name): MALIKA S. DE SILVA MD. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 ST GEORGES AVE SUITE104
COLONIA NJ
07067-3427
US

IV. Provider business mailing address

1503 ST GEORGES AVE SUITE104
COLONIA NJ
07067-3427
US

V. Phone/Fax

Practice location:
  • Phone: 732-388-5577
  • Fax:
Mailing address:
  • Phone: 732-388-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberMA07781900
License Number StateNJ

VIII. Authorized Official

Name: DR. MALIKA SHANI DE SILVA
Title or Position: ATTENDING
Credential: MD
Phone: 732-738-3244