Mallard Professional Services Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MALLARD PROFESSIONAL SERVICES INC

Practice address

5550 Merrick Rd
Massapequa, NY 11758-6238

Phone

(516) 814-2900

Fax

(631) 673-1314

NPI assigned

Jul 25, 2023

Organization subpart

No

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

Authorized official

Name

Donna Scoca

Title

Credentialing

Phone

(631) 673-3233

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690934400000",
    "number": "1699455519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5550 MERRICK RD",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117586238",
            "telephone_number": "516-814-2900",
            "fax_number": "631-673-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5550 MERRICK RD",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117586238",
            "telephone_number": "516-814-2900",
            "fax_number": "631-673-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD PROFESSIONAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A",
        "authorized_official_last_name": "SCOCA",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "631-673-3233"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrisovalantoy Makris, LCSW
• Beata A. Malachowska
• Amanda Lauren Malandruccolo
• Chetan Malhotra, M.D.
• Sheetal Malhotra, SLP
• Jaclyn Janet Malone
• Kyle Harrison Maloney
• Ashley Marie Maltby
• Athena Mamane, LPN
• Ashley Mancilla, FNP-BC

• Family Medicine Physician in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; 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.