Provider Demographics
NPI:1346331824
Name:MELTZER, ELYSE MICHELE (CPNP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:MICHELE
Last Name:MELTZER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 79TH ST APT 9J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6215
Mailing Address - Country:US
Mailing Address - Phone:212-860-6027
Mailing Address - Fax:212-722-2731
Practice Address - Street 1:240 E 109TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3703
Practice Address - Country:US
Practice Address - Phone:212-860-6027
Practice Address - Fax:212-722-2731
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381080363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics