Provider Demographics
NPI:1467102806
Name:ERICA MALLOY, PSYCHIATRIC NURSE PRACTITIONER, P.C.
Entity Type:Organization
Organization Name:ERICA MALLOY, PSYCHIATRIC NURSE PRACTITIONER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:516-266-6186
Mailing Address - Street 1:92-18 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693
Mailing Address - Country:US
Mailing Address - Phone:516-266-6186
Mailing Address - Fax:445-800-8689
Practice Address - Street 1:92-18 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693
Practice Address - Country:US
Practice Address - Phone:516-266-6186
Practice Address - Fax:445-800-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty