MEDICARE: EZZA MALIK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	011326	NY

General Provider Information

NPI Number	:	1417825050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZZA MALIK OD

Provider Business Mailing Address
First Line	:	1491 SHORE PKWY APT 1G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6325
Country	:	US
Telephone Number	:	718-577-8819
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4708
Country	:	US
Telephone Number	:	718-363-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	06/09/2026

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