Healthcare Provider Details

I. General information

NPI: 1861568602
Provider Name (Legal Business Name): KRISTIN ANN MALLON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 7TH AVE S
NEW YORK NY
10014-3132
US

IV. Provider business mailing address

358 BEECH ST
HACKENSACK NJ
07601-1344
US

V. Phone/Fax

Practice location:
  • Phone: 917-938-7745
  • Fax: 855-449-7548
Mailing address:
  • Phone: 718-612-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001235
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00050300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: