Individual
DR. LAURIE R MALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
801 CO OP CITY BLVD, BRONX, NY 10475-1603
(718) 239-6500
Mailing address
147 DEVON FARMS RD, STORMVILLE, NY 12582-5269
(845) 227-2756
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
166488-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118AE1
—
NY
Enumeration date
02/22/2007
Last updated
12/18/2008
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