Provider Demographics
NPI:1922852441
Name:MALIK, JILL MEREDITH (MA, MS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MEREDITH
Last Name:MALIK
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WHITE PLAINS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5523
Mailing Address - Country:US
Mailing Address - Phone:914-631-4618
Mailing Address - Fax:
Practice Address - Street 1:155 WHITE PLAINS RD STE 200
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5523
Practice Address - Country:US
Practice Address - Phone:914-631-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM0855X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health