Provider Demographics
NPI:1477935153
Name:BIALICK, MALLORIE BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:BROOKE
Last Name:BIALICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11025 RCA CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4269
Mailing Address - Country:US
Mailing Address - Phone:561-514-5822
Mailing Address - Fax:
Practice Address - Street 1:80 CROSSWAYS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2047
Practice Address - Country:US
Practice Address - Phone:516-944-3882
Practice Address - Fax:844-751-9263
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY308605207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty