Healthcare Provider Details

I. General information

NPI: 1508132390
Provider Name (Legal Business Name): AHMED MELEIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE # MC-55
ALBANY NY
12208-3835
US

IV. Provider business mailing address

391 MYRTLE AVE # MC-55
ALBANY NY
12208-3835
US

V. Phone/Fax

Practice location:
  • Phone: 518-264-2225
  • Fax:
Mailing address:
  • Phone: 518-264-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number304399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: