1538287982 NPI number — MISS MELANIE GOULD PA

Table of content: MISS MELANIE GOULD PA (NPI 1538287982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538287982 NPI number — MISS MELANIE GOULD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULD
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1538287982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 ITHACA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTIC BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11509-1322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-805-1752
Provider Business Mailing Address Fax Number:
516-239-6125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4915 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10034-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-567-9580
Provider Business Practice Location Address Fax Number:
212-567-9582
Provider Enumeration Date:
03/26/2007

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: 363AM0700X , with the licence number:  011503 , 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)

  • Identifier: 011503 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com