Provider Demographics
NPI:1053057000
Name:REDDY, MALIKA (DPM)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BERGEN STREET
Mailing Address - Street 2:PODIATRY SEVICE RM G-142
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-5088
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN STREET
Practice Address - Street 2:PODIATRY SEVICE RM G-142
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program