Healthcare Provider Details

I. General information

NPI: 1174903181
Provider Name (Legal Business Name): EMILY MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057-9248
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7504
  • Fax: 315-634-4677
Mailing address:
  • Phone: 315-472-7504
  • Fax: 315-634-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPPLIED
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: