Healthcare Provider Details

I. General information

NPI: 1407015654
Provider Name (Legal Business Name): MAUREEN ANN MALONE ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 25A
SMITHTOWN NY
11787-1348
US

IV. Provider business mailing address

535 ELWOOD RD
EAST NORTHPORT NY
11731-4806
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3000
  • Fax:
Mailing address:
  • Phone: 631-368-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: