Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MA10900500 | NJ |
NPI | 1003311937 |
---|---|
Provider Name | Tayyab Malik |
First Address | North Bergen, NJ 07047-6217 |
Second Address | Jersey City, NJ 07306-4002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2018 |
Last Update Date | 22/12/2021 |