Provider Demographics
NPI:1033270145
Name:MAQUINE, MELANIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:MAQUINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4942
Mailing Address - Country:US
Mailing Address - Phone:516-605-2900
Mailing Address - Fax:516-935-8826
Practice Address - Street 1:875 OLD COUNTRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4942
Practice Address - Country:US
Practice Address - Phone:516-605-2900
Practice Address - Fax:516-935-8826
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400144117Medicare PIN
G11753Medicare UPIN