Provider Demographics
NPI:1942504477
Name:MELLER, PAUL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:MELLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 COMMACK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3400
Mailing Address - Country:US
Mailing Address - Phone:631-858-1090
Mailing Address - Fax:631-499-0534
Practice Address - Street 1:283 COMMACK RD STE 210
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3400
Practice Address - Country:US
Practice Address - Phone:631-858-1090
Practice Address - Fax:631-499-0534
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0000X
NY010495103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily