Provider Demographics
NPI:1245328764
Name:MELAMEDOFF, MONICA M (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:MELAMEDOFF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:380 N BROADWAY
Practice Address - Street 2:SUITE L2
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2109
Practice Address - Country:US
Practice Address - Phone:516-931-1776
Practice Address - Fax:516-942-1940
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-11-12
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Provider Licenses
StateLicense IDTaxonomies
NY162566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4130207OtherAETNA
NY0C6533OtherHEALTH NET
NY15814OtherVYTRA
NY23E981OtherEMPIRE BC/BS
NYCP175OtherOXFORD
NY01227325Medicaid
NY162566OtherLICENCE
NYCP175OtherOXFORD