Provider Demographics
NPI:1629263397
Name:MELNYCHUK, ELIZABETH MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIA
Last Name:MELNYCHUK
Suffix:
Gender:F
Credentials:DO
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 419
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-0419
Mailing Address - Country:US
Mailing Address - Phone:914-277-5350
Mailing Address - Fax:
Practice Address - Street 1:357 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504
Practice Address - Country:US
Practice Address - Phone:914-277-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054752207Q00000X
NY198820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1629263397Other1316369895