Healthcare Provider Details

I. General information

NPI: 1053989558
Provider Name (Legal Business Name): MELISA ROSE KRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 06/12/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CYPRESS ST
FARMINGDALE NY
11735-5344
US

IV. Provider business mailing address

11 CYPRESS ST
FARMINGDALE NY
11735-5344
US

V. Phone/Fax

Practice location:
  • Phone: 516-633-7538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: