| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MALLORY NAKAMURA | 1558994574 | 2022-12-03 |
Mallory T Nakamura [F] graduated in 2019 and primarily specializes in Physician Assistant.
Mallory Nakamura is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1558994574. Registration indicates Mallory Nakamura is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant: Medical, ) (All Other Specialties & Provider Types, ) (Physician Assistant Medical, Physician Assistants & Advanced Practice Nursing Providers) (Physician Assistant, )
| PECOS ID | 1658709753 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mallory Nakamura PA |
| Practice Office Address | 4295 HEMPSTEAD TPKE BETHPAGE, NY US |
| Practice Office Telephone | 5165796000 |
| Mailing Address | 1400 PELHAM PKWY S STE 1213 BRONX, NY 104611197 US |
| Business Telephone | 7189185599 |
| Business Fax | 7189185593 |
| Code | Practice | License No State |
|---|---|---|
| 363AM0700X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant: Medical All Other Specialties & Provider Types Physician Assistant Medical Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | 024639
NY |