Provider Demographics
NPI:1659739290
Name:GAERTNER, MELIDA (MPA, MSED)
Entity Type:Individual
Prefix:MISS
First Name:MELIDA
Middle Name:
Last Name:GAERTNER
Suffix:
Gender:F
Credentials:MPA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1557
Mailing Address - Country:US
Mailing Address - Phone:347-279-7209
Mailing Address - Fax:
Practice Address - Street 1:111 LIVINGSTON ST STE 1101
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5068
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY1004057161252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes174400000XOther Service ProvidersSpecialist