Provider Demographics
NPI:1821019548
Name:GILBERT, MELVIN R (MD, MBA)
Entity Type:Individual
Prefix:PROF
First Name:MELVIN
Middle Name:R
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 BROADWAY
Mailing Address - Street 2:# 156
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7449
Mailing Address - Country:US
Mailing Address - Phone:917-921-0865
Mailing Address - Fax:
Practice Address - Street 1:2472 BROADWAY
Practice Address - Street 2:# 156
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7449
Practice Address - Country:US
Practice Address - Phone:917-921-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1558512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02239412Medicaid
NY96F29-1OtherBC-BS
NYE98543Medicare UPIN
NY96F29-1OtherBC-BS
NY109BI1Medicare ID - Type UnspecifiedMEDICARE