Healthcare Provider Details

I. General information

NPI: 1427139997
Provider Name (Legal Business Name): DIPAK K MALLIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 ST GEORGES AVE
RAHWAY NJ
07065
US

IV. Provider business mailing address

546 ST GEORGES AVE
RAHWAY NJ
07065
US

V. Phone/Fax

Practice location:
  • Phone: 732-381-3642
  • Fax: 732-396-4463
Mailing address:
  • Phone: 732-381-3642
  • Fax: 732-396-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA29179
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: