Provider Demographics
NPI:1467731802
Name:MELAMED, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MELAMED
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 1:30 W 60TH ST APT 10T
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7912
Mailing Address - Country:US
Mailing Address - Phone:917-647-0900
Mailing Address - Fax:
Practice Address - Street 1:30 W 60TH ST APT 10T
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7912
Practice Address - Country:US
Practice Address - Phone:917-647-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist