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General NPI Number Information
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NPI Number | 1366022915
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Entity Type | Individual
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Provider Name | IAN ALEXANDER MELLIS MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 622 W 168TH ST
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 212-305-5697
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Fax |
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Provider Business Mailing Address
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Address Line | 630 WEST 168TH ST PH 1564W
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | 327229
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | 327229
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207ZP0104X
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Taxonomy Name | Chemical Pathology Physician
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License Number | 327229
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 327229
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License Number State | NY
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