Provider Demographics
NPI:1891178919
Name:TAM, MELISSA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W 45TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4913
Mailing Address - Country:US
Mailing Address - Phone:212-321-0090
Mailing Address - Fax:646-779-8989
Practice Address - Street 1:25 W 45TH ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4913
Practice Address - Country:US
Practice Address - Phone:212-321-0090
Practice Address - Fax:646-779-8989
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY689655-1163W00000X
NY340291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04398243Medicaid
WI331946Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
NY00695941Medicaid
WI331944Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331009Medicare Oscar/Certification