Healthcare Provider Details

I. General information

NPI: 1154484525
Provider Name (Legal Business Name): SANDEEP MALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 ELTON AVE
BRONX NY
10451-4160
US

IV. Provider business mailing address

1434 WILLIAMSBRIDGE RD FL 2
BRONX NY
10461-2507
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-7736
  • Fax: 718-537-6180
Mailing address:
  • Phone: 718-618-0401
  • Fax: 347-479-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number254253
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number254253
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0012321
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number254253
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number254253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: