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Individual

MALLORY ENG BURGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, CPNP

Contact information

Practice address
728 N MAIN ST, NEW SQUARE, NY 10977-8916
(845) 354-9033
Mailing address
728 N MAIN ST, NEW SQUARE, NY 10977-8916
(845) 354-9033

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
617014
NY
163W00000X
Registered Nurse
R195051
MD
363LP0200X
Pediatric Nurse Practitioner
Primary
382293
NY
363LP0200X
Pediatric Nurse Practitioner
R195051
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
119591300
MD
Enumeration date
04/15/2011
Last updated
10/12/2012
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