Provider Demographics
NPI:1992785315
Name:MALLETT, ERROL CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ERROL
Middle Name:CHARLES
Last Name:MALLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6054
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-6054
Mailing Address - Country:US
Mailing Address - Phone:917-688-2534
Mailing Address - Fax:800-420-3318
Practice Address - Street 1:2101 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2910
Practice Address - Country:US
Practice Address - Phone:718-517-2900
Practice Address - Fax:718-891-6800
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146738174400000X
NY146738-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00848128Medicaid
NYB77664Medicare UPIN
NY00848128Medicaid