1669678736 NPI number — DR. MELISSA ALLISON PRICE MD

Table of content: DR. MELISSA ALLISON PRICE MD (NPI 1669678736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669678736 NPI number — DR. MELISSA ALLISON PRICE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
MELISSA
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ALLISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669678736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MERRITT BOULEVARD- MOUNT KISCO MEDICAL GROUP
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
FISHKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12524-2990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-765-4990
Provider Business Mailing Address Fax Number:
845-765-4981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MERRITT BOULEVARD- MOUNT KISCO MEDICAL GROUP
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-765-4990
Provider Business Practice Location Address Fax Number:
845-765-4981
Provider Enumeration Date:
06/25/2007

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 252132 , 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: 03349979 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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