Basic Information
| Provider Information | |||||||||
| NPI: | 1245328764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELAMEDOFF | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 S SERVICE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117472354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453000 | ||||||||
| FaxNumber: | 5169453131 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 N BROADWAY | ||||||||
| Address2: | SUITE L2 | ||||||||
| City: | JERICHO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117532109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169311776 | ||||||||
| FaxNumber: | 5169421940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 162566 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4130207 | 01 | NY | AETNA | OTHER | 0C6533 | 01 | NY | HEALTH NET | OTHER | 15814 | 01 | NY | VYTRA | OTHER | 23E981 | 01 | NY | EMPIRE BC/BS | OTHER | CP175 | 01 | NY | OXFORD | OTHER | 01227325 | 05 | NY | MEDICAID | 162566 | 01 | NY | LICENCE | OTHER |