Provider Demographics
NPI:1275580664
Name:HURT, MELVIN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:B
Last Name:HURT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2922
Mailing Address - Country:US
Mailing Address - Phone:631-255-7234
Mailing Address - Fax:631-920-5911
Practice Address - Street 1:25 W 45TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4902
Practice Address - Country:US
Practice Address - Phone:212-704-4310
Practice Address - Fax:212-704-4311
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01645569Medicaid
NYU56910Medicare UPIN
NY01645569Medicaid
NYP16401Medicare PIN
NY01943Medicare PIN