# MALLARD PROFESSIONAL SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699455519
- **Authorized official:** DONNA SCOCA (CREDENTIALING)
- **Authorized official phone:** (631) 673-3233

## Contact information

- **Practice address:** 5550 MERRICK RD, MASSAPEQUA, NY 11758-6238
- **Practice address phone:** (516) 814-2900
- **Practice address fax:** (631) 673-1314
- **Mailing address:** 5550 MERRICK RD, MASSAPEQUA, NY 11758-6238
- **Mailing address phone:** (516) 814-2900
- **Mailing address fax:** (631) 673-1314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 07/25/2023
- **Last updated:** 08/02/2023