Basic Information
Provider Information | |||||||||
NPI: | 1427194075 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MALEK | ||||||||
FirstName: | ASHRAF | ||||||||
MiddleName: | HOSSAIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOSSAIN | ||||||||
OtherFirstName: | AZM | ||||||||
OtherMiddleName: | ASHRAF | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 301 LIPPINCOTT DR STE 410 | ||||||||
Address2: |   | ||||||||
City: | MARLTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 080534197 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8563503408 | ||||||||
FaxNumber: | 8563550330 | ||||||||
Practice Location | |||||||||
Address1: | 63 KRESSON ROAD | ||||||||
Address2: | SUITE 105 | ||||||||
City: | CHERRY HILL | ||||||||
State: | NJ | ||||||||
PostalCode: | 08034 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8567969340 | ||||||||
FaxNumber: | 8565470390 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/30/2007 | ||||||||
LastUpdateDate: | 05/21/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 236819 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RI0008X | MD430677 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RI0008X | 25MA07973100 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RT0003X | 25MA07973100 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
ID | Type | State | Issuer | Description | 02815369 | 05 | NY |   | MEDICAID |