Provider Demographics
NPI:1457555245
Name:MALIK, MANISH GULSHAN (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:GULSHAN
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CAMPBELL DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046
Mailing Address - Country:US
Mailing Address - Phone:609-871-7070
Mailing Address - Fax:
Practice Address - Street 1:200 CAMPBELL DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046
Practice Address - Country:US
Practice Address - Phone:609-871-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442569207RC0000X
NJ25MA09320700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease