Provider Demographics
NPI:1376832121
Name:MULLALLY, JAMIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:MULLALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:914-457-1195
Practice Address - Street 1:19 BRADHURST AVE STE 3100N
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-372-7887
Practice Address - Fax:914-372-7884
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269533207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism