Healthcare Provider Details

I. General information

NPI: 1720149784
Provider Name (Legal Business Name): MELVIN H THORNTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE SUITE 4SW
NEW YORK NY
10016-5459
US

IV. Provider business mailing address

2 CASE CT
MONROE NY
10950-4942
US

V. Phone/Fax

Practice location:
  • Phone: 646-737-2470
  • Fax: 718-253-8117
Mailing address:
  • Phone: 646-737-2470
  • Fax: 718-253-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2177961
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number217796-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: