Healthcare Provider Details

I. General information

NPI: 1396238127
Provider Name (Legal Business Name): ERICA MALLOY PSYCHIATRIC NURSE PRACTITIONER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MARIETTA DR
WESTBURY NY
11590-1134
US

IV. Provider business mailing address

16 MARIETTA DR
WESTBURY NY
11590-1134
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-1225
  • Fax:
Mailing address:
  • Phone: 718-459-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401461
License Number StateNY

VIII. Authorized Official

Name: ERICA MALLOY
Title or Position: PRESIDENT
Credential: NP
Phone: 516-266-6186