Provider Demographics
NPI:1376204628
Name:MALIK, BERNARD THOMAS III (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:THOMAS
Last Name:MALIK
Suffix:III
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 WYTHE ST APT 358
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2283
Mailing Address - Country:US
Mailing Address - Phone:732-516-8177
Mailing Address - Fax:
Practice Address - Street 1:7 OLD CIDER MILL RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8663
Practice Address - Country:US
Practice Address - Phone:732-516-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02870171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist