Provider Demographics
NPI:1972726909
Name:AZAB, MALAK ISHAK (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:MALAK
Middle Name:ISHAK
Last Name:AZAB
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3507
Mailing Address - Country:US
Mailing Address - Phone:631-467-3381
Mailing Address - Fax:631-467-3383
Practice Address - Street 1:1787 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3507
Practice Address - Country:US
Practice Address - Phone:631-467-3381
Practice Address - Fax:631-467-3383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021295174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554823Medicaid
NYQ4W2JIMedicare ID - Type UnspecifiedGROUP NUMBER