Provider Demographics
NPI:1710261219
Name:MALEK, MOHSINHUSAIN SHAUKATHUSAIN (PT)
Entity Type:Individual
Prefix:
First Name:MOHSINHUSAIN
Middle Name:SHAUKATHUSAIN
Last Name:MALEK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17561 HILLSIDE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5771
Mailing Address - Country:US
Mailing Address - Phone:718-545-8877
Mailing Address - Fax:718-545-2002
Practice Address - Street 1:17561 HILLSIDE AVE STE 202
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5771
Practice Address - Country:US
Practice Address - Phone:718-545-8877
Practice Address - Fax:718-545-2002
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032873-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist