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NPI 1700805132

NPI 1700805132 : KAREN MELTON D.O. : LONG BEACH, NY

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General NPI Number Information
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    NPI Number           |    1700805132
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    Entity Type          |    Individual 
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    Provider Name        |    KAREN MELTON D.O.
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/18/2006
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    Last Update Date     |    01/19/2010
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Provider Practice Location Address
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    Address Line         |    761 FRANKLIN BLVD 
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    City                 |    LONG BEACH
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    State                |    NY
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    Zip                  |    11561-2450
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    Country              |    US
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    Telephone            |    516-897-2692
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    Fax                  |    516-897-0941
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Provider Business Mailing Address
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    Address Line         |    761 FRANKLIN BLVD 
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    City                 |    LONG BEACH
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    State                |    NY
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    Zip                  |    11561-2450
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    Country              |    US
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    Telephone            |    516-897-2692
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    Fax                  |    516-897-0941
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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        |    207Q00000X
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    Taxonomy Name        |    Family Medicine Physician
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    License Number       |    234510
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    License Number State |    NY
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