Provider Demographics
NPI:1174661664
Name:ALMELEH, JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:ALMELEH
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 1:60 SUTTON PLACE SOUTH
Mailing Address - Street 2:APARTMENT 9NS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4168
Mailing Address - Country:US
Mailing Address - Phone:212-752-8385
Mailing Address - Fax:
Practice Address - Street 1:340 EAST 52ND STREET
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6775
Practice Address - Country:US
Practice Address - Phone:212-355-4250
Practice Address - Fax:212-371-9062
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1239602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B14302Medicare UPIN
41A151Medicare ID - Type Unspecified