Provider Demographics
NPI:1629092259
Name:MELLER, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 85TH ST OFC 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0962
Mailing Address - Country:US
Mailing Address - Phone:212-988-3772
Mailing Address - Fax:212-861-4672
Practice Address - Street 1:35 E 85TH ST OFC 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0962
Practice Address - Country:US
Practice Address - Phone:212-988-3772
Practice Address - Fax:212-861-4672
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115934207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00267723OtherRAILROAD MEDICARE
712871Medicare ID - Type Unspecified
NYB79038Medicare UPIN
P00267723OtherRAILROAD MEDICARE