Organization
PEDI PRACTICES
Active
Other names
Pediatric Practice
Organization subpart
No
Provider details
NPI number
Authorized official
TAYYABA K MALIK MD (CEO/ SOLER OWNER)
(201) 217-1000
Entity
Organization
Contact information
Practice address
127 PALISADE AVE, JERSEY CITY, NJ 07306-1101
(201) 217-1000
(201) 217-3118
Mailing address
127 PALISADE AVE, JERSEY CITY, NJ 07306-1101
(201) 217-1000
(201) 217-3118
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MA060432
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001
PRUDENTIAL
NJ
01
—
2697096
GHI
NJ
05
—
2K3441
—
NJ
01
—
491427
AETNA
NJ
01
—
551491
EMPIRE BLUE CROSS BLUE SHIELD
NJ
05
—
HUL00007402
—
NJ
Enumeration date
12/04/2012
Last updated
04/17/2023
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