Healthcare Provider Details

I. General information

NPI: 1982854386
Provider Name (Legal Business Name): GARY MELLEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5214
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5214
US

V. Phone/Fax

Practice location:
  • Phone: 914-637-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY MELLEN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 631-669-1171