Provider Demographics
NPI:1487033965
Name:MILLER, MELANIE (LAC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 28TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1947
Mailing Address - Country:US
Mailing Address - Phone:347-437-7343
Mailing Address - Fax:
Practice Address - Street 1:27 W 20TH ST
Practice Address - Street 2:SUITE 607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3707
Practice Address - Country:US
Practice Address - Phone:347-437-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005559-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist