# MR. ABDELKADER MALLOUK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1407949621
- **Gender:** Man
- **Credential:** MD, OD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OE8142 | PA | — |
| 152W00000X | Optometrist | OPC3141 | FL | — |
| 152W00000X | Optometrist | T005983 | NY | — |
| 207Q00000X | Family Medicine Physician | 277295 | NY | Yes |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | 277295 | NY | — |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 04/11/2022