Individual
KIMBERLY MALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
147 BETHEL RD, ALBERTSON, NY 11507-2111
(631) 889-1311
Mailing address
147 BETHEL RD, ALBERTSON, NY 11507-2111
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
01/04/2019
Last updated
01/04/2019
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