Provider Demographics
NPI:1326490640
Name:MELO, MOISES
Entity Type:Individual
Prefix:MR
First Name:MOISES
Middle Name:
Last Name:MELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100-10 67TH RD.
Mailing Address - Street 2:APT. 3H
Mailing Address - City:FOREST HILLS
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:11375
Mailing Address - Country:UM
Mailing Address - Phone:646-836-4992
Mailing Address - Fax:
Practice Address - Street 1:10010 67TH RD
Practice Address - Street 2:APT. 3H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2753
Practice Address - Country:US
Practice Address - Phone:646-836-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator