Provider Demographics
NPI:1508929951
Name:PAIGE, MELANIE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PAIGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AIRPORT EXECUTIVE PARK
Mailing Address - Street 2:STE 205
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5262
Mailing Address - Country:US
Mailing Address - Phone:845-356-3610
Mailing Address - Fax:845-352-4003
Practice Address - Street 1:200 AIRPORT EXECUTIVE PARK
Practice Address - Street 2:STE 205
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5262
Practice Address - Country:US
Practice Address - Phone:845-356-3610
Practice Address - Fax:845-352-4003
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215556-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03378407Medicaid