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NPI Code Detail

MEDICARE: MELISSA OLSON RD, LMP

MEDICARE: MELISSA OLSON RD, LMP
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
1133V00000XRegistered Dietitian006334NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184740722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA OLSON RD, LMP
Provider Business Mailing Address
First Line : 60 MADISON AVE
Second Line : 5TH FLOOR
City : NEW YORK
State : NY
Zip : 10010-1600
Country : US
Telephone Number : 212-545-2439
Fax Number : 646-312-0481
Provider Business Practice Location Address
First Line : 1167 NOSTRAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11225-5417
Country : US
Telephone Number : 718-778-0198
Fax Number : 718-221-8169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 11/13/2012

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