Provider Demographics
NPI:1083655633
Name:BLEIBERG, MELVYN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:S
Last Name:BLEIBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3713
Mailing Address - Country:US
Mailing Address - Phone:914-576-6783
Mailing Address - Fax:
Practice Address - Street 1:80 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3713
Practice Address - Country:US
Practice Address - Phone:914-576-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124829207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00387408Medicaid
NY00387408Medicaid
NY10A271Medicare PIN