Provider Demographics
NPI:1578664942
Name:MALIK, ABDUL II
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:MALIK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16387
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-0487
Mailing Address - Country:US
Mailing Address - Phone:215-722-5110
Mailing Address - Fax:
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:STE 208
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1221
Practice Address - Country:US
Practice Address - Phone:215-722-5110
Practice Address - Fax:215-722-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068811L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
028777Medicare ID - Type Unspecified
G98245Medicare UPIN