Healthcare Provider Details

I. General information

NPI: 1972468379
Provider Name (Legal Business Name): ATARA MALEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 HEYSON RD
FAR ROCKAWAY NY
11691-5511
US

IV. Provider business mailing address

396 MARLBOROUGH RD
CEDARHURST NY
11516-1115
US

V. Phone/Fax

Practice location:
  • Phone: 718-868-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1912517251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: