Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 039554 | NY |
NPI | 1003998923 |
---|---|
Provider Name | Dr. Roman Stefan Melnyk |
First Address | New Hartford, NY 13413-2350 |
Second Address | New Hartford, NY 13413-2350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |