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General NPI Number Information
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NPI Number | 1134292105
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Entity Type | Organization
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Legal Business Name | POCONO EAR NOSE THROAT & FACIAL PLASTIC SURGERY, ASSOCIATES
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 296 EAST BROWN STREET
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-424-2830
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Fax | 570-424-1793
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Provider Business Mailing Address
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Address Line | 296 EAST BROWN STREET
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-424-2830
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Fax | 570-424-1793
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUSSAIN G MALIK
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Credential | MD FACS
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Telephone | 570-424-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 036586
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036586
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License Number State | PA
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