Provider Demographics
NPI:1205312758
Name:MALLON, BALEY
Entity type:Individual
Prefix:
First Name:BALEY
Middle Name:
Last Name:MALLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1064
Mailing Address - Country:US
Mailing Address - Phone:585-813-2980
Mailing Address - Fax:
Practice Address - Street 1:6 MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1064
Practice Address - Country:US
Practice Address - Phone:585-813-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332421164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse