1538514146 NPI number — MS. MELISSA LAVIN BURCHILL R.D. (REGISTERED DIA

Table of content: MS. MELISSA LAVIN BURCHILL R.D. (REGISTERED DIA (NPI 1538514146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538514146 NPI number — MS. MELISSA LAVIN BURCHILL R.D. (REGISTERED DIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURCHILL
Provider First Name:
MELISSA
Provider Middle Name:
LAVIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D. (REGISTERED DIA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538514146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 EAST 60TH ST.
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-737-9000
Provider Business Mailing Address Fax Number:
212-223-5700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 EAST 60TH ST. SUITE 302
Provider Second Line Business Practice Location Address:
COMPLETE WELLNESS
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-737-9000
Provider Business Practice Location Address Fax Number:
212-223-5700
Provider Enumeration Date:
05/02/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  605519-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)