Active NPI
Mallory Paige Carson, DO
- Pediatrics Physician
- Stony Brook, NY
National Provider Identifier
1376004044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 315114
- Practice address
- Stony Brook Children'S Department of Pediatrics
Stony Brook, NY 11794-0001 - Phone
- (631) 444-2020
- Fax
- (631) 444-2894
- NPI assigned
- Mar 26, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 315114 | NY | Primary |
Addresses
Primary practice location
Stony Brook Children'S Department of Pediatrics
Stony Brook, NY 11794-0001
Mailing address
9314 244TH St
Floral Park, NY 11001-3913
Phone (516) 509-4634
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 315114 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655942400000",
"number": "1376004044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9314 244TH ST",
"city": "FLORAL PARK",
"state": "NY",
"postal_code": "110013913",
"telephone_number": "516-509-4634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STONY BROOK CHILDREN'S DEPARTMENT OF PEDIATRICS",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117940001",
"telephone_number": "631-444-2020",
"fax_number": "631-444-2894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARSON",
"first_name": "MALLORY",
"middle_name": "PAIGE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-26",
"last_updated": "2022-06-23",
"certification_date": "2022-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "315114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.