Individual
WILLIAM KINNEY MALLON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
STONY BROOK MEDICINE DEPT OF EMERGENCY, HSC, LEVEL 4, ROOM 080, STONY BROOK, NY 11794-8350
(631) 444-2478
Mailing address
PO BOX 1554, STONY BROOK, NY 11790-0988
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
282233
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G640550
—
CA
Enumeration date
06/09/2006
Last updated
11/23/2015
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