Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA05731000 | NJ |
NPI | 1013984616 |
---|---|
Provider Name | Nisha Malik |
First Address | Buffalo, NY 14267-0002 |
Second Address | Long Branch, NJ 07740-5725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 14/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6186904 | (05) | NJ |
F82040 | (02) | NJ |