Healthcare Provider Details

I. General information

NPI: 1447561121
Provider Name (Legal Business Name): TAHSEEN RABIA MALIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 KINGS HWY SUITE 100
WEST DEPTFORD NJ
08096-3162
US

IV. Provider business mailing address

831 KINGS HIGHWAY SUITE 100
WEST DEPTFORD NJ
08096
US

V. Phone/Fax

Practice location:
  • Phone: 856-853-8730
  • Fax: 856-853-7063
Mailing address:
  • Phone: 856-853-8730
  • Fax: 856-853-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA70384
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: