Healthcare Provider Details

I. General information

NPI: 1639244221
Provider Name (Legal Business Name): NABIL N ABDELMALAK AND MARY S TAWFIK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 STEPHEN LOOP
STATEN ISLAND NY
10314-4863
US

IV. Provider business mailing address

46 STEPHEN LOOP
STATEN ISLAND NY
10314-4863
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-8074
  • Fax: 718-982-5077
Mailing address:
  • Phone: 718-982-8074
  • Fax: 718-982-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number215765
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number215284
License Number StateNY

VIII. Authorized Official

Name: DR. NABIL N ABDELMALAK
Title or Position: PRESIDENT
Credential: M.D
Phone: 718-982-8074