Healthcare Provider Details

I. General information

NPI: 1528276649
Provider Name (Legal Business Name): MELISSA RANDY GITMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MADISON AVE RM L9-52
NEW YORK NY
10029-6514
US

IV. Provider business mailing address

1425 MADISON AVE RM L9-52
NEW YORK NY
10029-6514
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8173
  • Fax: 212-427-3082
Mailing address:
  • Phone: 212-659-8173
  • Fax: 212-427-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number290598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: