=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427455815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANHATTAN MIND HEALTH WELLNESS PSYCHOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2014
-----------------------------------------------------
Last Update Date | 12/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 W 57TH ST SUITE 1703
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-896-1693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 COMMUNITY DR SUITE 306
-----------------------------------------------------
City | MANHASSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11030-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-497-0722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/MEMBER
-----------------------------------------------------
Name | DR. PERRY MELTZER
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 646-896-1693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 020182
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------