Healthcare Provider Details

I. General information

NPI: 1417825050
Provider Name (Legal Business Name): EZZA MALIK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 86TH ST
BROOKLYN NY
11209-4708
US

IV. Provider business mailing address

1491 SHORE PKWY APT 1G
BROOKLYN NY
11214-6325
US

V. Phone/Fax

Practice location:
  • Phone: 718-363-2020
  • Fax:
Mailing address:
  • Phone: 718-577-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: