Provider Demographics
NPI:1720408016
Name:RAUCH, MELISSA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:RAUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BLADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1380 NOEL CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1311
Mailing Address - Country:US
Mailing Address - Phone:516-650-6075
Mailing Address - Fax:
Practice Address - Street 1:3175 E TREMONT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5700
Practice Address - Country:US
Practice Address - Phone:718-239-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist