Individual
MR. ABDELKADER MALLOUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, OD
Contact information
Practice address
100 JOHN ROEMMELT DR STE 302, HORSEHEADS, NY 14845-8304
(607) 873-1810
(607) 562-3157
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OE8142
PA
152W00000X
Optometrist
OPC3141
FL
152W00000X
Optometrist
T005983
NY
207Q00000X
Family Medicine Physician
Primary
277295
NY
207QA0401X
Addiction Medicine (Family Medicine) Physician
277295
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01916898
—
NY
Enumeration date
10/02/2006
Last updated
04/11/2022
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