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General NPI Number Information
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NPI Number | 1598253759
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Entity Type | Individual
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Provider Name | NOEL MELON NUEVAS
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Gender | Male
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 63 08 39TH AVE
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 754-252-4892
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Fax |
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Provider Business Mailing Address
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Address Line | 4022 201ST ST # 2F
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City | BAYSIDE
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State | NY
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Zip | 11361-1837
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Country | US
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Telephone | 929-507-2685
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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