Healthcare Provider Details

I. General information

NPI: 1275580664
Provider Name (Legal Business Name): MELVIN B HURT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W 45TH ST SUITE 402
NEW YORK NY
10036-4902
US

IV. Provider business mailing address

50 S 24TH ST
WYANDANCH NY
11798-2922
US

V. Phone/Fax

Practice location:
  • Phone: 212-704-4310
  • Fax: 212-704-4311
Mailing address:
  • Phone: 631-255-7234
  • Fax: 631-920-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: