Provider Demographics
NPI:1487751624
Name:MELLEY, ERIN KATHLEEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MELLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BROADWAY STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8162
Mailing Address - Country:US
Mailing Address - Phone:212-982-8229
Mailing Address - Fax:646-792-3301
Practice Address - Street 1:928 BROADWAY STE 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8162
Practice Address - Country:US
Practice Address - Phone:212-982-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207974Medicare ID - Type Unspecified
IL2485009Medicare PIN
ILP60948Medicare UPIN