Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mallory Vicedomini, PA

Individual provider Physician Assistant · NPI 1447070909

Mallory Vicedomini, PA is a Physician Assistant in Union, New Jersey. Qualified in 2024, 2 years ago. Practices with Igea Brain and Spine, PA, an 18-clinician group and accepts Medicare assignment.

Years since qualifying
2
In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1057 Commerce Ave
Union, NJ 07083-5025
Phone: (866) 467-1770
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1447070909
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 10, 2024
Last updated in NPPESNovember 21, 2024
Certification dateNovember 21, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Igea Brain And Spine,Pa — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Union