Provider Demographics
NPI:1780789701
Name:VENTIMIGLIA, MELISSA MARGARET (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGARET
Last Name:VENTIMIGLIA
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 1:6829 FLEET ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5050
Mailing Address - Country:US
Mailing Address - Phone:516-384-7694
Mailing Address - Fax:
Practice Address - Street 1:32 W 96TH ST
Practice Address - Street 2:GARDEN APT A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6556
Practice Address - Country:US
Practice Address - Phone:212-662-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229332204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000044OtherMEDICARE PTAN
I00044Medicare UPIN
NY896131Medicare ID - Type Unspecified