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General NPI Number Information
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NPI Number | 1750276457
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Entity Type | Individual
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Provider Name | PAUL JOSEPH MALLIA MS, MBA, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 755 MONTAUK HWY STE 1
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City | OAKDALE
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State | NY
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Zip | 11769-1801
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Country | US
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Telephone | 631-739-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CAMPUS DR
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1103
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Country | US
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Telephone | 631-739-4210
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 357071
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 798704
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License Number State | NY
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