Provider Demographics
NPI:1487178273
Name:MURPHY, MELANIE JEAN (LMT, LAC, MS)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JEAN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LMT, LAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0528
Mailing Address - Country:US
Mailing Address - Phone:631-319-9424
Mailing Address - Fax:
Practice Address - Street 1:811 W JERICHO TPKE STE 203E
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3220
Practice Address - Country:US
Practice Address - Phone:631-319-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017811225700000X
NY003741171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFW97438YMedicaid