Healthcare Provider Details

I. General information

NPI: 1326132580
Provider Name (Legal Business Name): GAIL BERKSON MALLOY PHD RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JERICHO TPK SUITE 102
FLORAL PARK NY
11001-2019
US

IV. Provider business mailing address

20 ROCKAWAY AVE
ROCKVILLE CENTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-352-2018
  • Fax:
Mailing address:
  • Phone: 516-678-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number135733
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: