Provider Demographics
NPI:1912951757
Name:MELANIE KATES MD PC
Entity Type:Organization
Organization Name:MELANIE KATES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-641-0574
Mailing Address - Street 1:2130 FIVE MILE LINE RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2292
Mailing Address - Country:US
Mailing Address - Phone:585-641-0574
Mailing Address - Fax:585-641-0577
Practice Address - Street 1:2130 FIVE MILE LINE RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2292
Practice Address - Country:US
Practice Address - Phone:585-641-0574
Practice Address - Fax:585-641-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD01725Medicare UPIN
NYAA1527Medicare ID - Type Unspecified