Organization
MALLARD PROFESSIONAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA SCOCA (CREDENTIALING)
(631) 673-3233
Entity
Organization
Contact information
Practice address
5550 MERRICK RD, MASSAPEQUA, NY 11758-6238
(516) 814-2900
(631) 673-1314
Mailing address
5550 MERRICK RD, MASSAPEQUA, NY 11758-6238
(516) 814-2900
(631) 673-1314
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
07/25/2023
Last updated
08/02/2023
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