Provider Demographics
NPI:1821021072
Name:JONES-MALIK, MENDIS (NP)
Entity Type:Individual
Prefix:
First Name:MENDIS
Middle Name:
Last Name:JONES-MALIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4331
Mailing Address - Country:US
Mailing Address - Phone:718-253-7529
Mailing Address - Fax:
Practice Address - Street 1:324 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5602
Practice Address - Country:US
Practice Address - Phone:718-665-4300
Practice Address - Fax:718-665-2660
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360345363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245107Medicaid
NY00245107Medicaid
NYS58135Medicare UPIN