Provider Demographics
NPI:1316237878
Name:R CHRISTINE MELTON MD PC
Entity type:Organization
Organization Name:R CHRISTINE MELTON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARACCIOLO-WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-475-3791
Mailing Address - Street 1:247 3RD AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7457
Mailing Address - Country:US
Mailing Address - Phone:212-475-3791
Mailing Address - Fax:212-475-5228
Practice Address - Street 1:247 3RD AVE
Practice Address - Street 2:SUITE#202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7457
Practice Address - Country:US
Practice Address - Phone:212-475-3791
Practice Address - Fax:212-475-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00955899Medicaid
NY50A011Medicare UPIN