Provider Demographics
NPI:1992002034
Name:MALLANEY, MAE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:MARIE
Last Name:MALLANEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1320
Mailing Address - Country:US
Mailing Address - Phone:518-308-3380
Mailing Address - Fax:
Practice Address - Street 1:110 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1320
Practice Address - Country:US
Practice Address - Phone:518-308-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272594164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse