=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265941223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELEPURA MEDICAL P. C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2017
-----------------------------------------------------
Last Update Date | 01/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4720 CENTER BLVD APT 2503
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11109-5659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-355-8332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8539 257TH ST
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11001-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. FEBIN MELEPURA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-355-8332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------