Provider Demographics
NPI:1124021209
Name:MALIK, UMMEKALSOOM RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:UMMEKALSOOM
Middle Name:RAHMAN
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD
Mailing Address - Street 2:STE 311
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1103
Mailing Address - Country:US
Mailing Address - Phone:516-358-2400
Mailing Address - Fax:516-358-5454
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:STE 311
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1103
Practice Address - Country:US
Practice Address - Phone:516-358-2400
Practice Address - Fax:516-358-5454
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182743207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40Q371OtherBCBS
NY4569862OtherAETNA
NY3C1548OtherPHS
NY8725486007OtherCIGNA
NYAA71681OtherMDNY
NY2503643OtherGHI
NYP378916OtherOXFORD
NY182743OtherHIP
NYF15100Medicare UPIN
NYF15100Medicare ID - Type Unspecified