MEDICARE: DR. JENNIFER A MELLER M.D.

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	207R00000X	Internal Medicine Physician	209750	NY

General Provider Information

NPI Number	:	1851310346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER A MELLER M.D.

Provider Business Mailing Address
First Line	:	1020 PARK AVE
Second Line	:	FLOOR 1
City	:	NEW YORK
State	:	NY
Zip	:	10028-0913
Country	:	US
Telephone Number	:	646-403-9685
Fax Number	:	212-772-2877

Provider Business Practice Location Address
First Line	:	1020 PARK AVE
Second Line	:	FLOOR 1
City	:	NEW YORK
State	:	NY
Zip	:	10028-0913
Country	:	US
Telephone Number	:	646-403-9685
Fax Number	:	212-772-2877

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/10/2010

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