Healthcare Provider Details

I. General information

NPI: 1912132432
Provider Name (Legal Business Name): MELISSA J NICOSIA KURIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY WOODHULL MEDICAL & MENTAL HEALTH CENTER
BROOKLYN NY
11206
US

IV. Provider business mailing address

760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230 WOODHULL MEDICAL & MENTAL HEALTH CENTER
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax:
Mailing address:
  • Phone: 718-963-8000
  • Fax: 718-630-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number275974
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD60356687
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: