Healthcare Provider Details

I. General information

NPI: 1326677170
Provider Name (Legal Business Name): MELANIE HOTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD STE 212
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD STE 212
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-5700
  • Fax:
Mailing address:
  • Phone: 516-472-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number328287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: