Provider Demographics
NPI:1790057958
Name:WRIGHT, MELISSA DENISE (DPM)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:DENISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:DENISE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:740 64TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4714
Practice Address - Country:US
Practice Address - Phone:718-439-2000
Practice Address - Fax:718-439-2004
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006566213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03949180Medicaid
NY03949180Medicaid