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General NPI Number Information
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NPI Number | 1003311937
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Entity Type | Individual
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Provider Name | TAYYAB MALIK MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 855 VALLEY RD
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City | CLIFTON
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State | NJ
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Zip | 07013-2441
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Country | US
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Telephone | 201-596-6262
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Fax | 201-596-6299
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Provider Business Mailing Address
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Address Line | 250 MOONACHIE RD
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City | MOONACHIE
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State | NJ
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Zip | 07074-1378
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Country | US
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Telephone | 201-596-6262
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Fax | 201-596-6299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA10900500
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License Number State | NJ
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