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General NPI Number Information
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NPI Number | 1376204628
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Entity Type | Individual
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Provider Name | BERNARD THOMAS MALIK III MAC, L.AC
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 7 OLD CIDER MILL RD
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City | MANALAPAN
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State | NJ
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Zip | 07726-8663
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Country | US
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Telephone | 732-516-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 WYTHE ST APT 358
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2283
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Country | US
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Telephone | 732-516-8177
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02870
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License Number State | MD
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