Healthcare Provider Details

I. General information

NPI: 1811906563
Provider Name (Legal Business Name): TARIQ PASHA MALIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BROADWAY SUITE 100
ALBANY NY
12207
US

IV. Provider business mailing address

540 BROADWAY SUITE 100
ALBANY NY
12207
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-0808
  • Fax: 518-465-1450
Mailing address:
  • Phone: 518-465-0808
  • Fax: 518-465-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: