Sanford Mallin, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

124625 Issued in NY

Practice address

107 Nelson Ave
Staten Island, NY 10308-2710

Phone

(718) 356-3411

Fax

(718) 356-6900

NPI assigned

Oct 10, 2006

Last updated

Oct 1, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475280000000",
    "number": "1043307077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 NELSON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103082710",
            "telephone_number": "718-356-3411",
            "fax_number": "718-356-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 NELSON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103082710",
            "telephone_number": "718-356-3411",
            "fax_number": "718-356-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIN",
        "first_name": "SANFORD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "124625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra A Mallette, RN
• Amanda Nicole Mallia, FNP-BC
• Brianna Frances Mallia, M.S., CCC-SLP
• Daniela Rose Mallia, M.S. OTR/L
• Ali Imran Mallick
• Emily Sharon Mallinger, MD
• Scott Robert Mallon
• Ellen Malloy
• Amanda G Malone
• Kathleen Ann Malone, ANP, RN

• Specialist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.