Provider Demographics
NPI:1780934828
Name:WILKEN, MELANIE EICHELBAUM (MSED)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:EICHELBAUM
Last Name:WILKEN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 CARREL BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5916
Mailing Address - Country:US
Mailing Address - Phone:646-621-7444
Mailing Address - Fax:
Practice Address - Street 1:3726 CARREL BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5916
Practice Address - Country:US
Practice Address - Phone:646-621-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1249557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist