Provider Demographics
NPI:1295860682
Name:MALLIOS, THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:MALLIOS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E 76TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3104
Mailing Address - Country:US
Mailing Address - Phone:212-434-5393
Mailing Address - Fax:
Practice Address - Street 1:416 E 76TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3104
Practice Address - Country:US
Practice Address - Phone:212-434-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300111800Medicare PIN
P12339Medicare UPIN
NYVL3381Medicare PIN