Provider Demographics
NPI:1700805132
Name:MELTON, KAREN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2450
Mailing Address - Country:US
Mailing Address - Phone:516-897-2692
Mailing Address - Fax:516-897-0941
Practice Address - Street 1:761 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2450
Practice Address - Country:US
Practice Address - Phone:516-897-2692
Practice Address - Fax:516-897-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine