Provider Demographics
NPI:1447962808
Name:ADAMS, MALIK O (LMT)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:O
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WALKER WAY
Mailing Address - Street 2:
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4990
Mailing Address - Country:US
Mailing Address - Phone:518-365-3005
Mailing Address - Fax:
Practice Address - Street 1:14 WALKER WAY
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-4990
Practice Address - Country:US
Practice Address - Phone:518-365-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033025-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist