Provider Demographics
NPI:1154318939
Name:VISCUSI, MELINDA EARON (DPM)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:EARON
Last Name:VISCUSI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EDWARD J LEMPKA DR
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1036
Mailing Address - Country:US
Mailing Address - Phone:845-651-3668
Mailing Address - Fax:845-651-1697
Practice Address - Street 1:19 EDWARD J LEMPKA DR
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1036
Practice Address - Country:US
Practice Address - Phone:845-651-3668
Practice Address - Fax:845-651-1697
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0058182213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02544012Medicaid
NY02544012Medicaid
NYU98241Medicare UPIN
NY5101870001Medicare NSC
A400007653Medicare PIN