Healthcare Provider Details

I. General information

NPI: 1477132058
Provider Name (Legal Business Name): ALEXANDER M MALEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAPLE AVE STE 3B
RED BANK NJ
07701-1729
US

IV. Provider business mailing address

8431 117TH ST
RICHMOND HILL NY
11418-1402
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-2111
  • Fax:
Mailing address:
  • Phone: 347-545-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00379900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00379900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: