Provider Demographics
NPI:1740464213
Name:BOSTICK, MELISSA (RRT)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BEACH 105TH ST
Mailing Address - Street 2:APT 1T
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2602
Mailing Address - Country:US
Mailing Address - Phone:718-945-3033
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:RM. 13-120
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05656-1227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered