Provider Demographics
NPI:1205461928
Name:KING, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHAPEL ST STE 701
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1917
Mailing Address - Country:US
Mailing Address - Phone:718-858-9658
Mailing Address - Fax:718-858-9670
Practice Address - Street 1:25 CHAPEL ST STE 701
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1917
Practice Address - Country:US
Practice Address - Phone:718-858-9658
Practice Address - Fax:718-858-9670
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552829-1363L00000X
NY343005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner