Organization
SHAHLA MALLICK MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHLA MALLICK (DOCTOR)
(718) 833-7860
Entity
Organization
Contact information
Practice address
517 54TH ST, BROOKLYN, NY 11220-3114
(718) 833-7860
(718) 833-7861
Mailing address
208 PARKWAY DR, ROSLYN HEIGHTS, NY 11577-2737
(718) 833-7860
(718) 833-7861
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
217612
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02106307
—
NY
Enumeration date
02/04/2011
Last updated
06/04/2024
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