Provider Demographics
NPI:1447531231
Name:MALEK, MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MALEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MORAD
Other - Middle Name:
Other - Last Name:MALEK MANSOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 W 95TH ST
Mailing Address - Street 2:APT 10F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6331
Mailing Address - Country:US
Mailing Address - Phone:646-420-6446
Mailing Address - Fax:
Practice Address - Street 1:433 E 56TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2432
Practice Address - Country:US
Practice Address - Phone:212-644-1011
Practice Address - Fax:212-583-1150
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055798-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics