Provider Demographics
NPI:1992704233
Name:MELIS, JAMES MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:MELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:150-55 14TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357
Mailing Address - Country:US
Mailing Address - Phone:718-559-3300
Mailing Address - Fax:718-559-3349
Practice Address - Street 1:150-55 14TH AVENUE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2821
Practice Address - Country:US
Practice Address - Phone:718-559-3300
Practice Address - Fax:718-559-3349
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT042156207Q00000X
NY255584-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI26005Medicare UPIN
NY# G400010268Medicare PIN
NY# G400010268Medicare PIN