Provider Demographics
NPI:1083131635
Name:ERROL C. MALLETT MEDICAL PC
Entity Type:Organization
Organization Name:ERROL C. MALLETT MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-715-8453
Mailing Address - Street 1:7819 18TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1729
Mailing Address - Country:US
Mailing Address - Phone:347-462-4488
Mailing Address - Fax:
Practice Address - Street 1:7819 18TH AVE STE C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1729
Practice Address - Country:US
Practice Address - Phone:347-462-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2024-02-08
Deactivation Date:2023-10-12
Deactivation Code:
Reactivation Date:2024-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00848128Medicaid