Healthcare Provider Details

I. General information

NPI: 1700449873
Provider Name (Legal Business Name): KYLE MELFE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL
BRONX NY
10461-2720
US

IV. Provider business mailing address

109 FOREST RD
WALLKILL NY
12589-2918
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4460
  • Fax:
Mailing address:
  • Phone: 845-527-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number023449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: