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NPI Code Detail

MEDICARE: MR. OLEG MELNYK PA-C

MEDICARE: MR. OLEG MELNYK PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1407111891
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OLEG MELNYK PA-C
Provider Business Mailing Address
First Line : 168 MARYLAND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3039
Country : US
Telephone Number : 718-815-7347
Fax Number :
Provider Business Practice Location Address
First Line : 150 55TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-2508
Country : US
Telephone Number : 718-630-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2012
Last Update Date : 11/12/2015

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