Provider Demographics
NPI:1093020034
Name:JENNIFER A. MELLER, M.D. PLLC
Entity Type:Organization
Organization Name:JENNIFER A. MELLER, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-403-9685
Mailing Address - Street 1:1020 PARK AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0913
Mailing Address - Country:US
Mailing Address - Phone:646-403-9685
Mailing Address - Fax:212-772-2877
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0913
Practice Address - Country:US
Practice Address - Phone:646-403-9685
Practice Address - Fax:212-772-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG98470Medicare UPIN