Provider Demographics
NPI:1144263302
Name:ATIF B MALIK MD PC
Entity type:Organization
Organization Name:ATIF B MALIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:BABAR
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-626-0747
Mailing Address - Street 1:518-7 OLD POST ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:732-626-0747
Mailing Address - Fax:
Practice Address - Street 1:40 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1654
Practice Address - Country:US
Practice Address - Phone:732-626-0747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00606632081P2900X
VA01012379042081P2900X
CAA849062081P2900X
MA213-4502081P2900X
NJ25MA080332002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD013644P62Medicare ID - Type Unspecified
MDH93783Medicare UPIN