Healthcare Provider Details

I. General information

NPI: 1518588920
Provider Name (Legal Business Name): MELINA CHERIAN POOPPALLIL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINA NAYYER DDS

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 S LITTLE TOR RD
NEW CITY NY
10956-1427
US

IV. Provider business mailing address

13 RED OAK LN
CORTLANDT MANOR NY
10567-6136
US

V. Phone/Fax

Practice location:
  • Phone: 845-634-5208
  • Fax:
Mailing address:
  • Phone: 914-552-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61891
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: