Provider Demographics
NPI:1750383220
Name:MELCHOR, FLORANTE (MD)
Entity type:Individual
Prefix:
First Name:FLORANTE
Middle Name:
Last Name:MELCHOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BETHPAGE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1515
Mailing Address - Country:US
Mailing Address - Phone:516-935-1800
Mailing Address - Fax:516-935-4398
Practice Address - Street 1:120 BETHPAGE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:516-935-1800
Practice Address - Fax:516-935-4398
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17859551173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01243154Medicaid
NY30F461Medicare ID - Type Unspecified
NYE20025Medicare UPIN