Active NPI
Laurie R Mallis, MD
- Geriatric Medicine (Internal Medicine) Physician
- Bronx, NY
National Provider Identifier
1871628800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 166488-1
- Practice address
- 801 Co Op City Blvd
Bronx, NY 10475-1603 - Phone
- (718) 239-6500
- NPI assigned
- Feb 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 166488-1 | NY | Primary |
Addresses
Primary practice location
801 Co Op City Blvd
Bronx, NY 10475-1603
Mailing address
147 Devon Farms Rd
Stormville, NY 12582-5269
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118AE1 | Medicaid | NY |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166488-1 | NY | MD | Geriatric Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229558400000",
"number": "1871628800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 DEVON FARMS RD",
"city": "STORMVILLE",
"state": "NY",
"postal_code": "125825269",
"fax_number": "845-227-2756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 CO OP CITY BLVD",
"city": "BRONX",
"state": "NY",
"postal_code": "104751603",
"telephone_number": "718-239-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLIS",
"first_name": "LAURIE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-22",
"last_updated": "2008-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NY",
"license": "166488-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "118AE1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.