Provider Demographics
NPI:1043593684
Name:MELLMAN MEDICAL CENTER
Entity Type:Organization
Organization Name:MELLMAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCIM
Authorized Official - Phone:954-457-5989
Mailing Address - Street 1:19380 COLLINS AVE
Mailing Address - Street 2:SUITE 823
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2239
Mailing Address - Country:US
Mailing Address - Phone:954-457-5989
Mailing Address - Fax:305-397-2923
Practice Address - Street 1:19380 COLLINS AVE
Practice Address - Street 2:SUITE 823
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2239
Practice Address - Country:US
Practice Address - Phone:954-457-5989
Practice Address - Fax:305-397-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87352251H1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman FactorsGroup - Multi-Specialty