Provider Demographics
NPI:1235347790
Name:OCCHIOGROSSO, MALLAY BARCLAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLAY
Middle Name:BARCLAY
Last Name:OCCHIOGROSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:122 E. 42D ST., 32D FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10168
Mailing Address - Country:US
Mailing Address - Phone:347-946-2991
Mailing Address - Fax:888-959-6273
Practice Address - Street 1:122 E 42ND ST FL D32D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-0002
Practice Address - Country:US
Practice Address - Phone:347-946-2991
Practice Address - Fax:888-959-6273
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2350582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY692BP1Medicare PIN