Provider Demographics
NPI:1649392481
Name:MALLON, ELIZABETH LEE (MSPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:MALLON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 N STATE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1522
Mailing Address - Country:US
Mailing Address - Phone:914-762-2222
Mailing Address - Fax:914-762-9175
Practice Address - Street 1:584 N STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1522
Practice Address - Country:US
Practice Address - Phone:914-762-2222
Practice Address - Fax:914-762-9175
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5419612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist