Healthcare Provider Details

I. General information

NPI: 1578090411
Provider Name (Legal Business Name): RABIA N MALIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 04/14/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 RIVER RD
NEW MILFORD NJ
07646-3014
US

IV. Provider business mailing address

810 RIVER RD
NEW MILFORD NJ
07646-3014
US

V. Phone/Fax

Practice location:
  • Phone: 201-855-8495
  • Fax:
Mailing address:
  • Phone: 18-558-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125070513
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF307438
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number307438
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA10898900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: