Provider Demographics
NPI:1588974729
Name:DUPERVAL, MELISSA (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DUPERVAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0809
Mailing Address - Country:US
Mailing Address - Phone:212-744-6700
Mailing Address - Fax:212-744-6799
Practice Address - Street 1:993 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0809
Practice Address - Country:US
Practice Address - Phone:212-744-6700
Practice Address - Fax:212-744-6799
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255182207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology