Healthcare Provider Details

I. General information

NPI: 1801355094
Provider Name (Legal Business Name): KYLE MELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 HYLAN BLVD
STATEN ISLAND NY
10312-6540
US

IV. Provider business mailing address

576 VALLEY RD STE 233
WAYNE NJ
07470-3526
US

V. Phone/Fax

Practice location:
  • Phone: 917-920-3006
  • Fax: 531-200-0034
Mailing address:
  • Phone: 862-225-6867
  • Fax: 201-377-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number331291
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number331291
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA12449700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA12449700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: