Provider Demographics
NPI:1376906404
Name:ZANIEWSKI, MELANIE ELLEN
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELLEN
Last Name:ZANIEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10708 N GAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2527
Mailing Address - Country:US
Mailing Address - Phone:315-896-2654
Mailing Address - Fax:315-896-2717
Practice Address - Street 1:10708 N GAGE RD
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2527
Practice Address - Country:US
Practice Address - Phone:315-896-2654
Practice Address - Fax:315-896-2717
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003269-1225X00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No302R00000XManaged Care OrganizationsHealth Maintenance Organization