Healthcare Provider Details

I. General information

NPI: 1679509947
Provider Name (Legal Business Name): MELISSA M FOYE-PETRILLO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MCCLELLAN STREET SUITE G05
SCHENECTADY NY
12304-1020
US

IV. Provider business mailing address

624 MCCLELLAN STREET SUITE G05
SCHENECTADY NY
12304-1020
US

V. Phone/Fax

Practice location:
  • Phone: 518-347-5113
  • Fax: 518-347-5007
Mailing address:
  • Phone: 518-347-5113
  • Fax: 518-347-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239929-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239929
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: