Provider Demographics
NPI:1053483917
Name:O'NEILL, MELANIE BETH (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BETH
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:1345 RXR PLZ FL 13
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11556-1301
Practice Address - Country:US
Practice Address - Phone:516-453-0435
Practice Address - Fax:646-846-3283
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY241218207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02814166Medicaid