Healthcare Provider Details

I. General information

NPI: 1740788694
Provider Name (Legal Business Name): MELISSA MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 11/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SECOND AVENUE 1ST FLOOR, SUITE 16
NEW YORK NY
10003
US

IV. Provider business mailing address

303 SECOND AVENUE SUITE 16, 1ST FLOOR
NEW YORK NY
10003
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-6475
  • Fax:
Mailing address:
  • Phone: 347-922-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: