Healthcare Provider Details

I. General information

NPI: 1780877738
Provider Name (Legal Business Name): MELANIE A. JUNGREIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16959 137TH AVE
JAMAICA NY
11434-4517
US

IV. Provider business mailing address

1000 ZECKENDORF BLVD
GARDEN CITY NY
11530-2133
US

V. Phone/Fax

Practice location:
  • Phone: 718-525-5600
  • Fax: 718-527-0922
Mailing address:
  • Phone: 516-542-6880
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: