Provider Demographics
NPI:1780013276
Name:TEKESINOVIC, MALIK (MS)
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:TEKESINOVIC
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 TIEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6327
Mailing Address - Country:US
Mailing Address - Phone:646-457-9842
Mailing Address - Fax:
Practice Address - Street 1:2319 TIEMANN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6327
Practice Address - Country:US
Practice Address - Phone:646-457-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist