Healthcare Provider Details

I. General information

NPI: 1669948998
Provider Name (Legal Business Name): AISHA MALIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2018
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

506 6TH ST
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022813
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: