| Doctor Name: | MALLORY ENG BURGER |
| NPI Number: | 1104116763 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CPNP |
| License Number: | R195051 |
| Business Practice Address: | 728 N Main St New Square, NY - 109778916 |
| Business Phone Number: | 8453549033 |
| Business Fax Number: | |
| Mailing Address: | 728 N Main St, NEW SQUARE |
| State: | NY |
| Postal Code: | 109778916 |
| Phone Number: | 8453549033 |
| Fax Number: | |
| NPI Enumeration Date: | 04/15/2011 |
| NPI Last Update Date: | 10/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | R195051 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |