Provider Demographics
NPI:1114030707
Name:MELLINGHOFF, INGO K (MD)
Entity Type:Individual
Prefix:DR
First Name:INGO
Middle Name:K
Last Name:MELLINGHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:MAILBOX 20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:646-888-3036
Mailing Address - Fax:646-422-0856
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:MAILBOX 20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:646-888-3036
Practice Address - Fax:646-422-0856
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619530OtherMEDICAL PPIN #
CA00A619530OtherMEDICAL PPIN #
CAG79901Medicare UPIN