Provider Demographics
NPI:1578535209
Name:MELISO, VINCENT D (DPM)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:D
Last Name:MELISO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2421
Mailing Address - Country:US
Mailing Address - Phone:718-383-2518
Mailing Address - Fax:718-383-6717
Practice Address - Street 1:405 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2421
Practice Address - Country:US
Practice Address - Phone:718-383-2518
Practice Address - Fax:718-383-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004846-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4041580001Medicare NSC
NYP52661Medicare ID - Type Unspecified
NYU12311Medicare UPIN