Basic Information
| Provider Information | |||||||||
| NPI: | 1114985520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALIK | ||||||||
| FirstName: | JAVAID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST STE B06 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568681 | ||||||||
| FaxNumber: | 4035379007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1711 27TH ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403566740 | ||||||||
| FaxNumber: | 7403559281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 271685 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35.120658 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207QA0401X | 271685 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0401X | MD423112 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 208VP0014X | 35.120658 | OH | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1011409110004 | 05 | PA | MEDICAID | 03530458 | 05 | NY | MEDICAID | 1011409110003 | 05 | PA | MEDICAID |