Basic Information
| Provider Information | |||||||||
| NPI: | 1053685206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALLOY | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11406 FRANCIS LEWIS BLVD | ||||||||
| Address2: | |||||||||
| City: | CAMBRIA HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114111006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473665383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1623 KINGS HWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112291209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183751200 | ||||||||
| FaxNumber: | 7183823358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 401461 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.