Provider Demographics
NPI:1770853236
Name:PHILIP MELNEKOFF, PH.D.,PC
Entity Type:Organization
Organization Name:PHILIP MELNEKOFF, PH.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNEKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-928-2349
Mailing Address - Street 1:108 TERRYVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-0248
Mailing Address - Country:US
Mailing Address - Phone:631-928-2349
Mailing Address - Fax:
Practice Address - Street 1:108 TERRYVILLE ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-0248
Practice Address - Country:US
Practice Address - Phone:631-928-2349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty