MEDICARE: DR. MELISSA R ARBUCKLE MD, PHD

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
1	2084P0800X	Psychiatry Physician	225722	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	225722	OTHER	NY	STATE PHYSICIAN LICENSE

General Provider Information

NPI Number	:	1467521831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA R ARBUCKLE MD, PHD

Provider Business Mailing Address
First Line	:	1051 RIVERSIDE DR
Second Line	:	BOX 103
City	:	NEW YORK
State	:	NY
Zip	:	10032-1007
Country	:	US
Telephone Number	:	646-301-1797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 RIVERSIDE DR
Second Line	:	BOX 103
City	:	NEW YORK
State	:	NY
Zip	:	10032-1007
Country	:	US
Telephone Number	:	646-301-1797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2011

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