Provider Demographics
NPI:1689671778
Name:KALMENSON, MELVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
Last Name:KALMENSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAPLE DR
Mailing Address - Street 2:APT 3G
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2001
Mailing Address - Country:US
Mailing Address - Phone:516-487-7179
Mailing Address - Fax:
Practice Address - Street 1:453 MOTHER GASTON BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7617
Practice Address - Country:US
Practice Address - Phone:718-342-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT87415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112327142Medicaid
NYC95251Medicare PIN
NYT81415Medicare UPIN
NY112327142Medicaid