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NPI Code Detail

MEDICARE: MARK MALOOF

MEDICARE: MARK MALOOF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician311867NY

General Provider Information

NPI Number : 1487147823
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK MALOOF
Provider Business Mailing Address
First Line : 196 MERRICK RD
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-1420
Country : US
Telephone Number : 516-255-8400
Fax Number : 516-255-8450
Provider Business Practice Location Address
First Line : 196 MERRICK RD
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-1420
Country : US
Telephone Number : 516-255-8400
Fax Number : 516-255-8450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2018
Last Update Date : 12/10/2025

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Directions to “ MARK MALOOF ” Practice Location

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