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General NPI Number Information
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NPI Number | 1447561121
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Entity Type | Individual
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Provider Name | TAHSEEN RABIA MALIK MD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 831 KINGS HWY SUITE 100
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City | WEST DEPTFORD
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State | NJ
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Zip | 08096-3162
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Country | US
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Telephone | 856-853-8730
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Fax | 856-853-7063
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Provider Business Mailing Address
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Address Line | 831 KINGS HIGHWAY SUITE 100
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City | WEST DEPTFORD
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State | NJ
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Zip | 08096
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Country | US
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Telephone | 856-853-8730
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Fax | 856-853-7063
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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 | MA70384
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License Number State | NJ
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