Provider Demographics
NPI:1205044021
Name:ISRAEL, MELISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E 84TH ST
Mailing Address - Street 2:APT 36E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2000
Mailing Address - Country:US
Mailing Address - Phone:212-535-5955
Mailing Address - Fax:
Practice Address - Street 1:979 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6520
Practice Address - Country:US
Practice Address - Phone:718-698-1885
Practice Address - Fax:718-698-8499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice