Individual
MS. MAURA O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1050 CLOVE ROAD, STATEN ISLAND PHYSICIAN PRACTICE, STATEN ISLAND, NY 10304-5509
(718) 816-6440
(718) 816-3749
Mailing address
2791 RICHMOND AVE, SUITE 201, STATEN ISLAND, NY 10314-5882
(718) 816-6440
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F304408-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02990370
—
NY
Enumeration date
01/24/2008
Last updated
07/18/2013
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