Provider Demographics
NPI:1861464679
Name:MELMAN, DOUGLAS JASON (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JASON
Last Name:MELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WOODBURY RD
Mailing Address - Street 2:STE A
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2503
Mailing Address - Country:US
Mailing Address - Phone:516-496-9400
Mailing Address - Fax:516-496-9212
Practice Address - Street 1:800 WOODBURY RD
Practice Address - Street 2:STE A
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:516-496-9400
Practice Address - Fax:516-496-9212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2253281207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76382Medicare UPIN
NYW32821Medicare ID - Type Unspecified