MEDICARE: MENDIS JONES-MALIK N.P.

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	363LW0102X	Women's Health Nurse Practitioner	F360345	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821021072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENDIS JONES-MALIK N.P.

Provider Business Mailing Address
First Line	:	3717 AVENUE I
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4331
Country	:	US
Telephone Number	:	718-253-7529
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5602
Country	:	US
Telephone Number	:	718-665-4300
Fax Number	:	718-665-2660

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/24/2013

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