Provider Demographics
NPI:1699544643
Name:PANAMENO, MELVIN ADRIAN (COTA)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:ADRIAN
Last Name:PANAMENO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10233 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2010
Mailing Address - Country:US
Mailing Address - Phone:718-673-7999
Mailing Address - Fax:
Practice Address - Street 1:150 PURCHASE ST STE 9
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2143
Practice Address - Country:US
Practice Address - Phone:914-921-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010358-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant