Individual provider Active NPI

Jessica Marie Mallgraf, RN BSN

  • Registered Nurse
  • Flushing, NY
National Provider Identifier
1003789868
Registry record updated Sep 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
67-1243 Issued in NY
Practice address
5645 Main St
Flushing, NY 11355-5045
Phone
(718) 670-1100
NPI assigned
Sep 27, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 67-1243 NY Primary

Addresses

Primary practice location

5645 Main St
Flushing, NY 11355-5045

Mailing address

9932 66TH Rd Apt 3Z
Rego Park, NY 11374-4407

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
67-1243NYMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758931200000",
    "number": "1003789868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9932 66TH RD APT 3Z",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-670-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLGRAF",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "RN BSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-09-27",
        "last_updated": "2025-09-27",
        "certification_date": "2025-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "67-1243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.