MEDICARE: DR. JAMES C. MELILLO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	050857	NY

General Provider Information

NPI Number	:	1134234396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C. MELILLO DDS

Provider Business Mailing Address
First Line	:	7 HEMION RD
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-4903
Country	:	US
Telephone Number	:	845-357-3244
Fax Number	:	845-357-3251

Provider Business Practice Location Address
First Line	:	7 HEMION RD
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-4903
Country	:	US
Telephone Number	:	845-357-3244
Fax Number	:	845-357-3251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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