=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265548754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES P. MELONE, JR., M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 01/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 E 34TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-340-0000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 270
-----------------------------------------------------
City | MASSAPEQUA PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11762-0270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-264-2035
-----------------------------------------------------
Fax | 631-264-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHARLES P MELONE JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-340-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 107813
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------