Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 62837 | CO |
Y | 111NI0900X | Internist | 62837 | CO |
NPI | 1003213497 |
---|---|
Provider Name | Ryan Malik |
First Address | Brooklyn, NY 11206-4418 |
Second Address | Brooklyn, NY 11206-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 27/01/2022 |