Provider Demographics
NPI:1750381455
Name:ASIM R MALIK MD PC
Entity type:Organization
Organization Name:ASIM R MALIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-788-5588
Mailing Address - Street 1:188 OLD WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1100
Mailing Address - Country:US
Mailing Address - Phone:718-788-5588
Mailing Address - Fax:718-788-1484
Practice Address - Street 1:1224 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5106
Practice Address - Country:US
Practice Address - Phone:718-788-5588
Practice Address - Fax:718-788-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141998207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00773120Medicaid
NYC12341Medicare UPIN
NYW34111Medicare ID - Type Unspecified