Provider Demographics
NPI:1245403799
Name:HEND ABDELMALEK PA MD FAMILY PRACTICE
Entity Type:Organization
Organization Name:HEND ABDELMALEK PA MD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEND
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-429-3000
Mailing Address - Street 1:4558 SAN JUAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2051
Mailing Address - Country:US
Mailing Address - Phone:904-429-3000
Mailing Address - Fax:904-381-0543
Practice Address - Street 1:4558 SAN JUAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2051
Practice Address - Country:US
Practice Address - Phone:904-429-3000
Practice Address - Fax:904-381-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93970261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI61147Medicare UPIN