Basic Information
Provider Information
NPI: 1487769162
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALEK
FirstName: JUNAID
MiddleName: Y
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 16149
Address2:  
City: RUMFORD
State: RI
PostalCode: 029160697
CountryCode: US
TelephoneNumber: 4014539625
FaxNumber: 4014357069
Practice Location
Address1: 195 COLLYER ST
Address2: SUITE 302
City: PROVIDENCE
State: RI
PostalCode: 029041869
CountryCode: US
TelephoneNumber: 4017933236
FaxNumber: 4017935171
Other Information
ProviderEnumerationDate: 08/20/2006
LastUpdateDate: 05/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X230142MAN Allopathic & Osteopathic PhysiciansSurgery 
2086S0129XMD14234RIY Allopathic & Osteopathic PhysiciansSurgeryVascular Surgery

No ID Information.


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