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General NPI Number Information
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NPI Number | 1477935153
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Entity Type | Individual
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Provider Name | MALLORIE BROOKE BIALICK MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 80 CROSSWAYS PARK DR STE 100
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City | WOODBURY
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State | NY
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Zip | 11797-2047
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Country | US
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Telephone | 516-944-3882
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Fax | 844-751-9263
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Provider Business Mailing Address
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Address Line | 11025 RCA CENTER DR STE 300
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4269
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Country | US
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Telephone | 561-514-5822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 308605
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License Number State | NY
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