Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 40164 | MA |
NPI | 1154310332 |
---|---|
Provider Name | Dr. Avrohm Melnick |
First Address | Newton, MA 02462-1626 |
Second Address | Newton, MA 02462-1626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 04/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A66902 | (02) | MA |