Provider Demographics
NPI:1952824013
Name:MELTZER, RANDOLPH MARC (DC)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:MARC
Last Name:MELTZER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 UNIVERSITY PL STE 412
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4528
Mailing Address - Country:US
Mailing Address - Phone:212-255-6710
Mailing Address - Fax:
Practice Address - Street 1:99 UNIVERSITY PL STE 412
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4528
Practice Address - Country:US
Practice Address - Phone:212-255-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor