Healthcare Provider Details

I. General information

NPI: 1043670664
Provider Name (Legal Business Name): MELVIN ZAX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1610
US

IV. Provider business mailing address

103 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1610
US

V. Phone/Fax

Practice location:
  • Phone: 585-957-9235
  • Fax: 585-292-5847
Mailing address:
  • Phone: 585-957-9235
  • Fax: 585-292-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number001383
License Number StateNY

VIII. Authorized Official

Name: MELVIN ZAX
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 585-957-9235