Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2060981 | NY |
Y | 207RA0401X | Internist - Addiction Medicine | 206098-1 | NY |
N | 208D00000X | General Practice Physician | 206098 | NY |
NPI | 1427137256 |
---|---|
Provider Name | John Melbourne |
First Address | Scotia, NY 12302-2513 |
Second Address | Schenectady, NY 12305-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D83556 | (02) | NY |