Provider Demographics
NPI:1699175752
Name:PERLSON, MELANIE (CDE, RD, MS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PERLSON
Suffix:
Gender:F
Credentials:CDE, RD, MS
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:LEITNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27005 76TH AVE
Mailing Address - Street 2:T457A
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1402
Mailing Address - Country:US
Mailing Address - Phone:516-470-5482
Mailing Address - Fax:
Practice Address - Street 1:285E MAIN ST 105
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2912
Practice Address - Country:US
Practice Address - Phone:631-509-0390
Practice Address - Fax:631-656-0875
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1026400133V00000X
261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical