Provider Demographics
NPI:1104903988
Name:MELAMED, JAKOB CYNA (MD)
Entity type:Individual
Prefix:DR
First Name:JAKOB
Middle Name:CYNA
Last Name:MELAMED
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 1:2600 NETHERLAND AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4801
Mailing Address - Country:US
Mailing Address - Phone:718-543-1300
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4801
Practice Address - Country:US
Practice Address - Phone:718-543-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01036873Medicaid
NY05E811Medicare ID - Type Unspecified
NY01036873Medicaid
NY05E812Medicare ID - Type Unspecified
NY01036873Medicaid