Provider Demographics
NPI:1144383696
Name:MELMAN, YELENA
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:MELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BROADWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4917
Mailing Address - Country:US
Mailing Address - Phone:631-563-2294
Mailing Address - Fax:631-589-8946
Practice Address - Street 1:800 BROADWAY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4917
Practice Address - Country:US
Practice Address - Phone:631-563-2294
Practice Address - Fax:631-589-8946
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163622208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01040082Medicaid
NY01040082Medicaid