Healthcare Provider Details

I. General information

NPI: 1982273116
Provider Name (Legal Business Name): ANDREW MALEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FAMILY PRACTICE DR
KINGSTON NY
12401-6449
US

IV. Provider business mailing address

1990 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-6400
  • Fax: 845-339-7288
Mailing address:
  • Phone: 985-868-9300
  • Fax: 985-851-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number343756
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: